Stroke recurrence risk is higher for black survivors

  • Kamel H & al.
  • JAMA Neurol
  • 24 Feb 2020

  • curated by Susan London
  • Clinical Essentials
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Takeaway

  • Black patients had a 60% higher adjusted risk for recurrence within 90 days of a minor ischemic stroke or transient ischemic attack (TIA) compared with white counterparts.

Why this matters

  • Findings may support risk-stratified poststroke care, with intensified secondary intervention efforts for black survivors.

Key results

  • Cumulative 90-day risk for new ischemic stroke:
    • 8.5% among black patients and
    • 5.3% among white patients.
  • Fully adjusted recurrence risk was higher for black vs white patients (HR, 1.6; 95% CI, 1.1-2.3).
  • Findings were similar:
    • Disregarding the incident event (TIA vs minor stroke),
    • Restricting analyses to sites enrolling black patients,
    • Using propensity score adjustment, and
    • Imputing missing race/ethnicity.
  • No significant interaction between black race and age, treatment assignment, lacunar vs nonlacunar index event, baseline systolic BP.
  • Risk not significantly increased for patients of other races.

Study design

  • Secondary analysis of US multicenter randomized controlled trial of antiplatelet therapy for minor ischemic stroke or high-risk TIA (POINT trial).
  • 4044 adults within 12 hours of onset: 72.7% white, 22.7% black, 4.5% of other races.
  • Main outcome: new ischemic stroke within 90 days.
  • Funding: National Institute of Neurological Disorders and Stroke; NIH.

Limitations

  • Uncertain generalizability.
  • Residual, unmeasured confounding.
  • Lack of follow-up beyond 90 days.