国家神经系统疾病临床医学研究中心数据管理与共享系统
Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases
Association of elevated hs-CRP and multiple infarctions with outcomes of minor stroke or TIA: subgroup analysis of CHANCE randomised clinical trial
基本信息
- 负责人：Guangyao Wang,Jing Jing
- 数据来源： CHANCE
- 论文编号：CHANCE20190902
- 发表时间：2020-09-21
2020-09-21
已发表文章
发表杂志：Stroke and Vascular Neurology
发表类型: Original Contributions
影响因子(IF): 4.081
PMID: 32958697 Pubmed原文链接 全文下载
主要研究背景及目的
Higher rate of stroke recurrence has been reported in stroke patients with despite multiple acute infarctions (MAIs) despite treatment with dual-antiplatelet medications, which might be partly due to underlying inflammation. MAIs usually had higher risk of stroke recurrence than single acute infarction(SAI) and no acute infarction(NAI) in minor stroke and transient ischemic attack. High hsCRP levels predict recurrent stroke in acute patients with minor stroke or transient ischemic attack. However, among patients after stroke, it is lack studies about the relationship of hsCRP and the effects of dual and single antiplatelet therapy in patients with different infarction patterns. We sought to investigate the relationship of hsCRP and the effects of dual and single antiplatelet therapy in patients with and without MAIs using the CHANCE trial.
方法
A subset of 807 patients with both hs-CRP measurement and baseline MRI was included from the Clopidogrel in High-risk Patients with Acute Non-disabling Cerebrovascular Events trial. The primary efficacy outcome was the occurrence of an ischaemic stroke at the 1-year follow-up. Infarction numbers were classified as multiple acute infarctions (MAIs), single acute infarction and no acute infarction (NAI). The association between different hs-CRP levels with different infarction numbers and the risk of any outcome was analysed using multivariable Cox regression models.
结论
Combined elevated hs-CRP levels and MAIs may increase 1-year stroke risk stratification efficiency in patients with minor ischaemic stroke or TIA compared with using those markers alone, which indicated that the combination of inflammatory and imaging markers might improve the effectiveness of risk stratification concerning minor ischaemic stroke or TIA.
主要结果
Among the 807 patients, 84 (10.4%) patients had a recurrent ischaemic stroke within 1 year. After adjustment for conventional confounding factors, patients with both elevated hs-CRP levels and MAIs were associated with approximately 4.7-fold of risk of ischaemic stroke within 1 year (16.7% vs 3.5%, HR 4.68, 95% CI 1.54 to 14.23, p=0.007), compared with those with non-elevated hs-CRP levels and NAI. Similar results were observed for the composite events.