Background: TIAregistry.org is an international, multicenter-cooperative, prospective registry in patients with TIA or minor stroke within 7 days after the onset. Main analyses of one-year follow-up data have been reported (N Engl J Med 2016;374:1533-42). This was the second report on Japanese sub-analysis of TIAregistry.org.
Methods: The patients recruited in TIAregistry.org were classified into two groups (345 Japanese and 3,238 non-Japanese). We compared subtype of acute cerebrovascular syndrome (ACVS) at baseline and recurrent ischemic stroke subtype according to the TOAST classification during one-year follow-up period as well as short- to long- term risk of stroke between Japanese and non-Japanese patients. We also determined predictors of one-year stroke in Japanese patients.
Results: There was significant difference between Japanese and non-Japanese in the baseline ACVS subtype (38.3% vs 22.9% in small vessel occlusion, and 13% vs 33.9% in undetermined cause, p <0.001) and recurrent stroke subtype (8.0% vs 17.4% in cardio-embolism, 24.0% vs 3.7% in other determined cause, and 4.0% vs 24.2% in undetermined cause, p< 0.001). The risk of stroke at 2-day was similar between Japanese and non-Japanese, while the risk at 7-, 30- and 90-day, and 12-month were higher in Japanese than in non-Japanese. The risks of recurrent stroke in Japanese were diabetes mellitus (HR 2.88, 95% CI 1.06-4.90, p = 0.03), regular alcohol consumption (HR 2.56, 95% CI 1.15-5.78, p = 0.02), and large artery atherosclerosis in TOAST classification (HR 8.35, 95% CI 1.16-63.43, p = 0.02). In multi-variate analysis, the significant predictors of one-year stroke risk were prior coronary artery disease (HR 6.08, 95% CI 1.28-28.81, p = 0.02) and regular alcohol consumption (HR 2.28, 95% CI 1.02-5.17, p = 0.04).
Conclusions: There were differences in baseline TOAST classification and recurrent TOAST stroke subtype between Japanese and non-Japanese. The very short-term risk of stroke was similar between Japanese and non-Japanese, while the later-term risk was higher in Japanese than in non-Japanese. The independent predictors of one-year stroke were history of coronary artery disease and regular alcohol drinking in Japanese patients.