Contemporary management (2015-2018) of minor ischemic stroke or TIA was associated with lower 12-month stroke recurrence (8.29% vs 15.38%) compared to the 2007-2008 cohort.
Cohort (n=15,352)
Yes
Does contemporary management compared to historical management improve prognosis in patients with minor ischemic stroke or TIA?
Over a decade, increased use of dual antiplatelet therapy and statin adherence in China was associated with significant reductions in stroke recurrence, disability, and mortality following minor ischemic stroke or TIA.
Absolute Event Rate: 8.29% vs 15.38%
BACKGROUND: Real-world data on the long-term trends in risk factors, acute antithrombotic strategies, medication adherence, and their impact on the prognosis of minor ischemic stroke (MIS) or transient ischemic attack (TIA) are limited. METHODS: We analyzed cases of acute MIS (National Institutes of Health Stroke Scale score ⩽ 3) and TIA from the China National Stroke Registries (CNSRs), a series of multicenter, nationwide hospital-based registries in China. Stroke risk factors, acute antithrombotic strategies, and adherence to secondary prevention were compared between CNSR I (2007-2008) and CNSR III (2015-2018). The main outcomes were stroke recurrence, disability (modified Rankin Scale 3-5), and all-cause mortality at 3, 6, and 12 months of follow-up. RESULTS: In total, 15,352 patients with acute MIS or TIA were included, including 7,013 patients from CNSR I and 8,339 patients from CNSR III. Over the past decade, there has been a 10-fold increase in the acute use of dual antiplatelet therapy (3.15% in CNSR I vs 31.75% in CNSR III) and a seven-fold increase in statin adherence at the 12 month follow-up (10.56% in CNSR I vs 71.15% in CNSR III). It was also observed that the adjusted cumulative incidence of stroke recurrence (15.38% 15.29%-15.47% vs 8.29% 8.27%-8.32%), disability rates (11.29% 11.12%-11.46% vs 4.38% 4.32%-4.44%), and all-cause mortality (8.17% 8.04%-8.30% vs 1.86% 1.83%-1.89%) at the 12-month follow-up showed a marked decline over the decade. Risk factors such as age (per 10 years), diabetes, and prior stroke were linked to a higher risk of 12-month stroke recurrence in CNSR I (CNSR I: odds ratio (OR) and 95% confidence interval (CI), 1.25 1.17-1.33 for age per 10 years; 1.40 1.18-1.66 for diabetes; and 1.96 1.68-2.27 for prior stroke), and these associations remained significant after 10 years (CNSR III: OR and 95% CI, 1.15 1.08-1.24 for age per 10 years; 1.35 1.13-1.61 for diabetes; and 1.54 1.29-1.84 for prior stroke). CONCLUSION: The past decade has witnessed significant advancements in both acute antithrombotic strategies and medication adherence, accompanied by marked reductions in stroke recurrence, disability, and mortality. These improvements highlight a positive shift toward more effective evidence-based care for patients with MIS or TIA.
Jiang et al. (Wed,) conducted a cohort in Acute minor ischemic stroke or transient ischemic attack (TIA) (n=15,352). Contemporary management (CNSR III cohort, 2015-2018) vs. Historical management (CNSR I cohort, 2007-2008) was evaluated on Stroke recurrence at 12 months. Contemporary management (2015-2018) of minor ischemic stroke or TIA was associated with lower 12-month stroke recurrence (8.29% vs 15.38%) compared to the 2007-2008 cohort.