Predictors of stroke recurrence in patients with recent lacunar stroke and response to interventions according to risk status: Secondary prevention of small subcortical strokes trial

Robert G. Hart, Lesly A. Pearce, Majid F. Bakheet, Oscar R. Benavente, Robin A. Conwit, Leslie A. McClure, Robert Talbert, David C. Anderson

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background Among participants in the Secondary Prevention of Small Subcortical Strokes randomized trial, we sought to identify patients with high versus low rates of recurrent ischemic stroke and to assess effects of aggressive blood pressure control and dual antiplatelet therapy according to risk status. Methods Multivariable analyses of 3020 participants with recent magnetic resonance imaging-defined lacunar strokes followed for a mean of 3.7 years with 243 recurrent ischemic strokes. Results Prior symptomatic lacunar stroke or transient ischemic attack (TIA) (hazard ratio [HR] 2.2, 95% confidence interval [CI] 1.6, 2.9), diabetes (HR 2.0, 95% CI 1.5, 2.5), black race (HR 1.7, 95% CI 1.3, 2.3), and male sex (HR 1.5, 95% CI 1.1, 1.9) were each independently predictive of recurrent ischemic stroke. Recurrent ischemic stroke occurred at a rate of 4.3% per year (95% CI 3.4, 5.5) in patients with prior symptomatic lacunar stroke or TIA (15% of the cohort), 3.1% per year (95% CI 2.6, 3.9) in those with more than 1 of the other 3 risk factors (27% of the cohort), and 1.3% per year (95% CI 1.0, 1.7) in those with 0-1 risk factors (58% of the cohort). There were no significant interactions between treatment effects and stroke risk status. Conclusions In this large, carefully followed cohort of patients with recent lacunar stroke and aggressive blood pressure management, prior symptomatic lacunar ischemia, diabetes, black race, and male sex independently predicted ischemic stroke recurrence. The effects of blood pressure targets and dual antiplatelet therapy were similar across the spectrum of independent risk factors and recurrence risk.

Original languageEnglish (US)
Pages (from-to)618-624
Number of pages7
JournalJournal of Stroke and Cerebrovascular Diseases
Volume23
Issue number4
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Lacunar Stroke
Secondary Prevention
Stroke
Confidence Intervals
Recurrence
Transient Ischemic Attack
Blood Pressure
Sex Ratio
Therapeutics
Ischemia
Magnetic Resonance Imaging

Keywords

  • cerebral small-vessel disease
  • Lacunar infarct
  • prognosis
  • recurrent stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Rehabilitation
  • Cardiology and Cardiovascular Medicine

Cite this

Predictors of stroke recurrence in patients with recent lacunar stroke and response to interventions according to risk status : Secondary prevention of small subcortical strokes trial. / Hart, Robert G.; Pearce, Lesly A.; Bakheet, Majid F.; Benavente, Oscar R.; Conwit, Robin A.; McClure, Leslie A.; Talbert, Robert; Anderson, David C.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 23, No. 4, 2014, p. 618-624.

Research output: Contribution to journalArticle

Hart, Robert G. ; Pearce, Lesly A. ; Bakheet, Majid F. ; Benavente, Oscar R. ; Conwit, Robin A. ; McClure, Leslie A. ; Talbert, Robert ; Anderson, David C. / Predictors of stroke recurrence in patients with recent lacunar stroke and response to interventions according to risk status : Secondary prevention of small subcortical strokes trial. In: Journal of Stroke and Cerebrovascular Diseases. 2014 ; Vol. 23, No. 4. pp. 618-624.
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abstract = "Background Among participants in the Secondary Prevention of Small Subcortical Strokes randomized trial, we sought to identify patients with high versus low rates of recurrent ischemic stroke and to assess effects of aggressive blood pressure control and dual antiplatelet therapy according to risk status. Methods Multivariable analyses of 3020 participants with recent magnetic resonance imaging-defined lacunar strokes followed for a mean of 3.7 years with 243 recurrent ischemic strokes. Results Prior symptomatic lacunar stroke or transient ischemic attack (TIA) (hazard ratio [HR] 2.2, 95{\%} confidence interval [CI] 1.6, 2.9), diabetes (HR 2.0, 95{\%} CI 1.5, 2.5), black race (HR 1.7, 95{\%} CI 1.3, 2.3), and male sex (HR 1.5, 95{\%} CI 1.1, 1.9) were each independently predictive of recurrent ischemic stroke. Recurrent ischemic stroke occurred at a rate of 4.3{\%} per year (95{\%} CI 3.4, 5.5) in patients with prior symptomatic lacunar stroke or TIA (15{\%} of the cohort), 3.1{\%} per year (95{\%} CI 2.6, 3.9) in those with more than 1 of the other 3 risk factors (27{\%} of the cohort), and 1.3{\%} per year (95{\%} CI 1.0, 1.7) in those with 0-1 risk factors (58{\%} of the cohort). There were no significant interactions between treatment effects and stroke risk status. Conclusions In this large, carefully followed cohort of patients with recent lacunar stroke and aggressive blood pressure management, prior symptomatic lacunar ischemia, diabetes, black race, and male sex independently predicted ischemic stroke recurrence. The effects of blood pressure targets and dual antiplatelet therapy were similar across the spectrum of independent risk factors and recurrence risk.",
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T1 - Predictors of stroke recurrence in patients with recent lacunar stroke and response to interventions according to risk status

T2 - Secondary prevention of small subcortical strokes trial

AU - Hart, Robert G.

AU - Pearce, Lesly A.

AU - Bakheet, Majid F.

AU - Benavente, Oscar R.

AU - Conwit, Robin A.

AU - McClure, Leslie A.

AU - Talbert, Robert

AU - Anderson, David C.

PY - 2014

Y1 - 2014

N2 - Background Among participants in the Secondary Prevention of Small Subcortical Strokes randomized trial, we sought to identify patients with high versus low rates of recurrent ischemic stroke and to assess effects of aggressive blood pressure control and dual antiplatelet therapy according to risk status. Methods Multivariable analyses of 3020 participants with recent magnetic resonance imaging-defined lacunar strokes followed for a mean of 3.7 years with 243 recurrent ischemic strokes. Results Prior symptomatic lacunar stroke or transient ischemic attack (TIA) (hazard ratio [HR] 2.2, 95% confidence interval [CI] 1.6, 2.9), diabetes (HR 2.0, 95% CI 1.5, 2.5), black race (HR 1.7, 95% CI 1.3, 2.3), and male sex (HR 1.5, 95% CI 1.1, 1.9) were each independently predictive of recurrent ischemic stroke. Recurrent ischemic stroke occurred at a rate of 4.3% per year (95% CI 3.4, 5.5) in patients with prior symptomatic lacunar stroke or TIA (15% of the cohort), 3.1% per year (95% CI 2.6, 3.9) in those with more than 1 of the other 3 risk factors (27% of the cohort), and 1.3% per year (95% CI 1.0, 1.7) in those with 0-1 risk factors (58% of the cohort). There were no significant interactions between treatment effects and stroke risk status. Conclusions In this large, carefully followed cohort of patients with recent lacunar stroke and aggressive blood pressure management, prior symptomatic lacunar ischemia, diabetes, black race, and male sex independently predicted ischemic stroke recurrence. The effects of blood pressure targets and dual antiplatelet therapy were similar across the spectrum of independent risk factors and recurrence risk.

AB - Background Among participants in the Secondary Prevention of Small Subcortical Strokes randomized trial, we sought to identify patients with high versus low rates of recurrent ischemic stroke and to assess effects of aggressive blood pressure control and dual antiplatelet therapy according to risk status. Methods Multivariable analyses of 3020 participants with recent magnetic resonance imaging-defined lacunar strokes followed for a mean of 3.7 years with 243 recurrent ischemic strokes. Results Prior symptomatic lacunar stroke or transient ischemic attack (TIA) (hazard ratio [HR] 2.2, 95% confidence interval [CI] 1.6, 2.9), diabetes (HR 2.0, 95% CI 1.5, 2.5), black race (HR 1.7, 95% CI 1.3, 2.3), and male sex (HR 1.5, 95% CI 1.1, 1.9) were each independently predictive of recurrent ischemic stroke. Recurrent ischemic stroke occurred at a rate of 4.3% per year (95% CI 3.4, 5.5) in patients with prior symptomatic lacunar stroke or TIA (15% of the cohort), 3.1% per year (95% CI 2.6, 3.9) in those with more than 1 of the other 3 risk factors (27% of the cohort), and 1.3% per year (95% CI 1.0, 1.7) in those with 0-1 risk factors (58% of the cohort). There were no significant interactions between treatment effects and stroke risk status. Conclusions In this large, carefully followed cohort of patients with recent lacunar stroke and aggressive blood pressure management, prior symptomatic lacunar ischemia, diabetes, black race, and male sex independently predicted ischemic stroke recurrence. The effects of blood pressure targets and dual antiplatelet therapy were similar across the spectrum of independent risk factors and recurrence risk.

KW - cerebral small-vessel disease

KW - Lacunar infarct

KW - prognosis

KW - recurrent stroke

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