Five-year prognosis after TIA or minor ischemic stroke in Asian and non-Asian countries

Objective We aimed to determine long-term vascular outcomes of Asian patients who experienced TIA or minor ischemic stroke and to compare the outcomes of Asians with those of non-Asians, in the context of modern guideline-based prevention strategies. Methods This is a sub-analysis of the TIAregistry.org project, in which 3,847 patients (882 from Asian and 2,965 from non-Asian countries) with a recent TIA or minor ischemic stroke were assessed and treated by specialists at 42 dedicated units from 14 countries and followed for 5 years. The primary outcome was a composite of cardiovascular death, non-fatal stroke, and non-fatal acute coronary syndrome. Results No differences were observed in the 5-year risk of the primary outcome (14.0% vs 11.7%; hazard ratio [HR], 1.10; 95% CI, 0.88–1.37; p = 0.41) and stroke (10.7% vs 8.5%; HR, 1.17; 95% CI, 0.90–1.51; p = 0.24) between Asian and non-Asian patients. Asians were at higher risk of intracranial hemorrhage (1.8% vs 0.8%; HR, 2.23; 95% CI, 1.09–4.57; p = 0.029). Multivariable analysis showed that the presence of multiple acute infarctions on initial brain imaging was an independent predictor of primary outcome and modified Rankin Scale score of >1 in both Asian (HR, 1.91; 95% CI, 1.11–3.29; p = 0.020) and non-Asian (HR, 1.39; 95% CI, 1.02–1.90; p = 0.037) patients. Conclusion The long-term risk of vascular events in Asian patients was as low as that in non-Asian patients, while Asians had a 2.2-fold higher intracranial hemorrhage risk. Multiple acute infarctions were independently associated with future disability in both groups. Classification of evidence This study provides Class I evidence that among people who experienced TIA or minor stroke, Asians have a similar 5-year risk of cardiovascular death, stroke and acute coronary syndrome as non-Asians.