Association of Black Race With Early Recurrence After Minor Ischemic Stroke or Transient Ischemic Attack: Secondary Analysis of the POINT Randomized Clinical Trial.,JAMA Neurology

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Association of Black Race With Early Recurrence After Minor Ischemic Stroke or Transient Ischemic Attack: Secondary Analysis of the POINT Randomized Clinical Trial.
JAMA Neurology ( IF 20.4 ) Pub Date : 2020-05-01 , DOI: 10.1001/jamaneurol.2020.0010
Hooman Kamel _{1,

2} , Cenai Zhang ₁ , Dawn O Kleindorfer ₃ , Emily B Levitan ₄ , Virginia J Howard ₄ , George Howard ₅ , Elsayed Z Soliman _{6,

7,

8} , S Claiborne Johnston ₉

Affiliation

Importance Stroke incidence is higher among black than white individuals in the United States. It is unclear whether black individuals have a higher risk of stroke recurrence after a minor ischemic stroke or transient ischemic attack (TIA), a high-risk setting in which focused preventive efforts can be effective. Objective To examine the association between black race and early ischemic stroke recurrence. Design, Setting, and Participants This cohort study analyzed data from the Platelet Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trial conducted at 269 sites from May 28, 2010, to December 19, 2017. The trial enrolled 4881 adults within 12 hours of onset of a minor ischemic stroke (National Institutes of Health Stroke Scale score, 0-3) or high-risk TIA (ABCD2 score, ≥4). For this analysis, we excluded 598 patients enrolled outside the United States and 239 US patients with missing race/ethnicity data. Main Outcomes and Measures The primary outcome for this analysis was ischemic stroke within 90 days after randomization. Covariates included age, sex, Hispanic ethnicity, study assignment to take clopidogrel vs placebo, index stroke vs TIA, vascular risk factors, statin use, study drug adherence, and index event etiological subtype. Results Among 4044 patients included in the analysis, 918 (22.7%) were black. In an adjusted Cox model, black race was associated with a higher risk of recurrence compared with white race (hazard ratio, 1.6; 95% CI, 1.1-2.3). Findings were similar in subgroup analyses and in analyses limited to sites that enrolled black patients. Conclusions and Relevance Among US participants in the POINT trial, black individuals faced a higher risk of early stroke recurrence after a minor ischemic stroke or TIA. Our findings support research into black-white racial differences in the underlying mechanisms of recurrent stroke. In the meantime, extra effort should be made to ensure that black patients have access to proven secondary prevention measures. Trial Registration clinicaltrials.gov Identifier: NCT00991029.

中文翻译：

黑人种族与轻度缺血性中风或短暂性脑缺血发作后早期复发的关联：POINT 随机临床试验的二次分析。

重要性在美国，黑人的中风发病率高于白人。目前尚不清楚黑人个体在轻度缺血性中风或短暂性脑缺血发作 (TIA) 后是否具有更高的中风复发风险，在这种高风险环境中，集中预防措施可能是有效的。目的探讨黑人种族与早期缺血性卒中复发的关系。设计、设置和参与者本队列研究分析了 2010 年 5 月 28 日至 2017 年 12 月 19 日在 269 个地点进行的新 TIA 和轻微缺血性卒中中的血小板定向抑制 (POINT) 试验的数据。该试验招募了 12 年中的 4881 名成年人轻微缺血性卒中（美国国立卫生研究院卒中量表评分，0-3）或高危 TIA（ABCD2 评分，≥4）的发作时间。对于本次分析，我们排除了在美国境外登记的 598 名患者和 239 名缺少种族/民族数据的美国患者。主要结果和测量该分析的主要结果是随机分组后 90 天内的缺血性卒中。协变量包括年龄、性别、西班牙裔、服用氯吡格雷与安慰剂的研究分配、指数中风与 TIA、血管危险因素、他汀类药物的使用、研究药物依从性和指数事件病因亚型。结果在纳入分析的 4044 名患者中，918 名（22.7%）为黑人。在调整后的 Cox 模型中，与白人相比，黑人与更高的复发风险相关（风险比，1.6；95% CI，1.1-2.3）。在亚组分析和仅限于招募黑人患者的地点的分析中，结果相似。结论和相关性在 POINT 试验的美国参与者中，黑人个体在轻微缺血性卒中或 TIA 后面临较高的早期卒中复发风险。我们的研究结果支持对复发性卒中潜在机制中的黑白种族差异的研究。与此同时，应加倍努力确保黑人患者能够获得经过验证的二级预防措施。试验注册临床试验.gov 标识符：NCT00991029。

更新日期：2020-05-01

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