Dual antiplatelet therapy in stroke and ICAS: Subgroup analysis of CHANCE
Liping Liu, Ka Sing Lawrence Wong, Xinyi Leng, Yuehua Pu, Yilong Wang, Jing Jing, Xinying Zou, Yuesong Pan, Anxin Wang, Xia Meng, Chunxue Wang, Xingquan Zhao, Yannie Soo, S Claiborne Johnston, Yongjun Wang, CHANCE Investigators, Zhimin Wang, Yongjun Wang, Haiqin Xia, Bin Li, Guiru Zhang, Xudong Ren, Chunling Ji, Guohua Zhang, Jianhua Li, Bohua Lu, Liping Wang, Shutao Feng, Dali Wang, Weiguo Tang, Juntao Li, Hongtian Zhang, Guanglai Li, Baojun Wang, Yuhua Chen, Ying Lian, Bin Liu, Junfang Teng, Rubo Sui, Lejun Li, Zhiling Yuan, Dawei Zang, Zuneng Lu, Li Sun, Dong Wang, Liying Hou, Dongcai Yuan, Yongliang Cao, Hui Li, Xiuge Tan, Huicong Wang, Haisong Du, Mingyi Liu, Suping Wang, Qiuwu Liu, Zhong Zhang, Qifu Cui, Runqing Wang, Jialin Zhao, Jiewen Zhang, Jianping Zhao, Qi Bi, Xiyou Qi, Junyan Liu, Changxin Li, Ling Lv Li, Xiaoping Pan, Junling Zhang, Derang Jiao, Zhao Han, Dawei Qian, Jin Xiao, Yan Xing, Huishan Du, Guang Huang, Yongqiang Cui, Yan Li, Lianyuan Feng, Lianbo Gao, Bo Xiao, Yibin Cao, Yiping Wu, Jinfeng Liu, Zhiming Zhang, Zhengxie Dong, Limin Wang, Xinchen Wang, Xueying Guo, Ming Wang, Xiaosha Wang, Jiandong Jiang, Renliang Zhao, Shengnian Zhou, Hao Hu, Maolin He, Fengchun Yu, Quping Ouyang, Jingbo Zhang, Anding Xu, Xiaokun Qi, Lei Wang, Fuming Shi, Fuqiang Guo, Jianfeng Wang, Fengli Zhao, Ronghua Dou, Dongning Wei, Qingwei Meng, Yilu Xia, Shimin Wang, Zhangcang Xue, Yuming Xu, Liping Ma, Chun Wang, Jiang Wu, Yifeng Du, Yinzhou Wang, Lijun Xiao, Fucong Song, Wenli Hu, Zhigang Chen, Qingrui Liu, Jiemin Zhang, Mei Chen, Xiaodong Yuan, Zhihui Liu, Guozhong Li, Xiaohong Li, Tingchen Tian, Liping Liu, Ka Sing Lawrence Wong, Xinyi Leng, Yuehua Pu, Yilong Wang, Jing Jing, Xinying Zou, Yuesong Pan, Anxin Wang, Xia Meng, Chunxue Wang, Xingquan Zhao, Yannie Soo, S Claiborne Johnston, Yongjun Wang, CHANCE Investigators, Zhimin Wang, Yongjun Wang, Haiqin Xia, Bin Li, Guiru Zhang, Xudong Ren, Chunling Ji, Guohua Zhang, Jianhua Li, Bohua Lu, Liping Wang, Shutao Feng, Dali Wang, Weiguo Tang, Juntao Li, Hongtian Zhang, Guanglai Li, Baojun Wang, Yuhua Chen, Ying Lian, Bin Liu, Junfang Teng, Rubo Sui, Lejun Li, Zhiling Yuan, Dawei Zang, Zuneng Lu, Li Sun, Dong Wang, Liying Hou, Dongcai Yuan, Yongliang Cao, Hui Li, Xiuge Tan, Huicong Wang, Haisong Du, Mingyi Liu, Suping Wang, Qiuwu Liu, Zhong Zhang, Qifu Cui, Runqing Wang, Jialin Zhao, Jiewen Zhang, Jianping Zhao, Qi Bi, Xiyou Qi, Junyan Liu, Changxin Li, Ling Lv Li, Xiaoping Pan, Junling Zhang, Derang Jiao, Zhao Han, Dawei Qian, Jin Xiao, Yan Xing, Huishan Du, Guang Huang, Yongqiang Cui, Yan Li, Lianyuan Feng, Lianbo Gao, Bo Xiao, Yibin Cao, Yiping Wu, Jinfeng Liu, Zhiming Zhang, Zhengxie Dong, Limin Wang, Xinchen Wang, Xueying Guo, Ming Wang, Xiaosha Wang, Jiandong Jiang, Renliang Zhao, Shengnian Zhou, Hao Hu, Maolin He, Fengchun Yu, Quping Ouyang, Jingbo Zhang, Anding Xu, Xiaokun Qi, Lei Wang, Fuming Shi, Fuqiang Guo, Jianfeng Wang, Fengli Zhao, Ronghua Dou, Dongning Wei, Qingwei Meng, Yilu Xia, Shimin Wang, Zhangcang Xue, Yuming Xu, Liping Ma, Chun Wang, Jiang Wu, Yifeng Du, Yinzhou Wang, Lijun Xiao, Fucong Song, Wenli Hu, Zhigang Chen, Qingrui Liu, Jiemin Zhang, Mei Chen, Xiaodong Yuan, Zhihui Liu, Guozhong Li, Xiaohong Li, Tingchen Tian
Abstract
AB OBJECTIVE: We aimed to investigate whether the efficacy and safety of clopidogrel plus aspirin vs aspirin alone were consistent between patients with and without intracranial arterial stenosis (ICAS), in the Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial.
Methods: We assessed the interaction of the treatment effects of the 2 antiplatelet therapies among patients with and without ICAS, identified by magnetic resonance angiography (MRA) in CHANCE (ClinicalTrials.gov identifier NCT00979589).
Results: Overall, 1,089 patients with MRA images available in CHANCE were included in this subanalysis, 608 patients (55.8%) with ICAS and 481 (44.2%) without. Patients with ICAS had higher rates of recurrent stroke (12.5% vs 5.4%; p<0.0001) at 90 days than those without. But there was no statistically significant treatment by presence of ICAS interaction on either the primary outcome of any stroke (hazard ratio for clopidogrel plus aspirin vs aspirin alone: 0.79 [0.47-1.32] vs 1.12 [0.56-2.25]; interaction p=0.522) or the safety outcome of any bleeding event (interaction p=0.277).
Conclusions: The results indicated higher rate of recurrent stroke in minor stroke or high-risk TIA patients with ICAS than in those without. However, there was no significant difference in the response to the 2 antiplatelet therapies between patients with and without ICAS in the CHANCE trial. Classification of evidence: This study provides Class II evidence that for patients with acute minor stroke or TIA with and without ICAS identified by MRA, clopidogrel plus aspirin is not significantly different than aspirin alone in preventing recurrent stroke.
© 2015 American Academy of Neurology.
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Source: PubMed