Genotype-Guided Dual Antiplatelet Use for Transient Ischemic Attack and Minor Stroke by Imaging Status: Subgroup Analysis of the CHANCE-2 Trial

Jing, Jing; Xie, Xuewei; Johnston, S. Claiborne; Bath, Philip M.; Li, Zixiao; Zhao, Xingquan; Liu, Liping; Wang, Yilong; Xu, Qin; Wang, Anxin; Jiang, Yong; Li, Hao; Meng, Xia; Wang, Yongjun; for the CHANCE‐2 Investigators

Abstract

Objective: This study was performed to investigate whether ticagrelor/aspirin versus clopidogrel/aspirin can further reduce the residual risk of stroke recurrence in patients with positive diffusion-weighted imaging (DWI) in the High-Risk Patients with Acute Nondisabling Cerebrovascular Events II (CHANCE-2) trial. Methods: Patients with DWI data in the CHANCE-2 trial were included and divided into those with and without acute infarction according to their DWI findings. The primary efficacy outcome and safety outcome were stroke recurrence and moderate to severe bleeding within 3 months of follow-up, respectively. Results: Of the 6,412 patients enrolled in the CHANCE-2 trial, 5,796 (90.4%) patients with DWI data were included in the subgroup analysis. A total of 4,369 patients (75.4%) had an acute infarction on DWI. Patients with positive DWI had higher risk of recurrent stroke (8.1%) than those without infarction (2.2%) within 3-month follow-up. Compared with clopidogrel/aspirin, ticagrelor/aspirin was associated with lower risk of stroke in patients with positive DWI (hazard ratio [HR] = 0.65, 95% confidence interval [CI] = 0.52–0.80, p< 0.001) than in those negative DWI (HR=1.22, 95% CI=0.55–2.72, p= 0.63), with a significant interaction association (p for interaction=0.049). The risk of moderate to severe bleeding was similar between ticagrelor/aspirin and clopidogrel/aspirin treatment in the different groups. Interpretation: Our study demonstrates that imaging evaluation should be emphasized before targeting the best candidates for genotype-guided dual antiplatelet therapy in future clinical research and practice. ANN NEUROL 2023.

Citation

Jing, J., Xie, X., Johnston, S. C., Bath, P. M., Li, Z., Zhao, X., Liu, L., Wang, Y., Xu, Q., Wang, A., Jiang, Y., Li, H., Meng, X., Wang, Y., & for the CHANCE‐2 Investigators. (2023). Genotype-Guided Dual Antiplatelet Use for Transient Ischemic Attack and Minor Stroke by Imaging Status: Subgroup Analysis of the CHANCE-2 Trial. Annals of Neurology, 93(4), 783-792. https://doi.org/10.1002/ana.26589

• Journal Article Type: Article
• Acceptance Date: Dec 23, 2022
• Online Publication Date: Dec 26, 2022
• Publication Date: 2023-04
• Deposit Date: Jan 5, 2023
• Publicly Available Date: Dec 27, 2023
• Journal: Annals of Neurology
• Print ISSN: 0364-5134
• Electronic ISSN: 1531-8249
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 93
• Issue: 4
• Pages: 783-792
• DOI: https://doi.org/10.1002/ana.26589
• Keywords: Neurology (clinical); Neurology
• Public URL: https://nottingham-repository.worktribe.com/output/15715319
• Publisher URL: https://onlinelibrary.wiley.com/doi/abs/10.1002/ana.26589
• Additional Information: This is the pre-peer reviewed version of the following article: Jing, J., Xie, X., Johnston, S.C., Bath, P.M., Li, Z., Zhao, X., Liu, L., Wang, Y., Xu, Q., Wang, A., Jiang, Y., Li, H., Meng, X., Wang, Y. and (2023), Genotype-guided dual antiplatelet use for TIA and minor stroke by imaging status: a subgroup analysis of the CHANCE-2 trial. Ann Neurol. Accepted Author Manuscript, which has been published in final form at https://doi.org/10.1002/ana.26589.