Key result
Patients with coexistent cerebral small vessel disease and multiple acute infarctions had an approximately 9.5-fold increased risk of recurrent stroke at 1 year compared to those with neither condition (HR 9.560).
Why the study?
The association between different cerebral small vessel disease status, infarction number, and recurrence after acute minor stroke and transient ischaemic attack had not been established.
Does the coexistence of cerebral small vessel disease and multiple acute infarctions predict recurrent stroke in patients with acute minor stroke and TIA?
Observational (n=886)
Double-blind
Yes
Does the coexistence of cerebral small vessel disease and multiple acute infarctions predict recurrent stroke in patients with acute minor stroke and TIA?
Hazard Ratio: 9.56 (95% CI 1.273–71.787)
Absolute Event Rate: 17.4% vs 1.7%
p-value: p=0.028
The coexistence of cerebral small vessel disease and multiple acute infarctions strongly predicts a higher risk of recurrent stroke at 1 year in patients with acute minor stroke or TIA.
May inform closer monitoring after minor stroke/TIA; leaves open whether targeted interventions reduce recurrence in this subgroup.
BACKGROUND AND PURPOSE: To investigate the association of different status of cerebral small vessel disease (CSVD) and infarction number with recurrence after acute minor stroke and transient ischaemic attack (TIA). METHODS: This study was a post hoc analysis of the Clopidogrel in High-risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial, and includes 886 patients with acute minor stroke and TIA. The status of CSVD and infarction number was recorded for each individual. Infarction number were classified as multiple acute infarctions (MAIs≥2), single acute infarction (SAI =1), and non-acute infarction (NAI =0). The CSVD burden were grouped into non-CSVD (0 score) and CSVD (1-4 score). The primary outcome was a recurrent stroke at the 1-year follow-up. The secondary outcomes were recurrent ischaemic stroke, composite vascular event (CVE), and TIA. We analyzed the relationships between different status of CSVD burden and infarction pattern with the risk of outcomes using multivariable Cox regression models. RESULTS: Among all 886 patients included in present analysis, recurrent stroke was occurred in 93 (10.5%) patients during 1-year follow-up. After adjusted for all potential covariates, compared with patients with non-CSVD and NAI, patients with CSVD and MAIs were associated with approximately 9.5-fold increased risk of recurrent stroke at 1 year (HR 9.560, 95% CI 1.273-71.787, p=0.028). Similar results observed in ischaemic stroke and CVE. CONCLUSION: The status of CSVD and infarction number predicted recurrent stroke in patients with acute minor stroke and TIA, especially for those with coexistent CSVD and MAIs.
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Tian et al. (2022) conducted an observational in Acute minor stroke and transient ischaemic attack (TIA) (n=886). Coexistent cerebral small vessel disease (CSVD) and multiple acute infarctions (MAIs) vs. Non-CSVD and non-acute infarction (NAI) was evaluated on Recurrent stroke at 1-year follow-up (HR 9.560, 95% CI 1.273-71.787, p=0.028). Patients with coexistent cerebral small vessel disease and multiple acute infarctions had an approximately 9.5-fold increased risk of recurrent stroke at 1 year compared to those with neither condition (HR 9.560).
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