Ticagrelor Versus Clopidogrel in Minor Stroke or Transient Ischemic Attack With Intracranial Artery Stenosis: A Post Hoc Analysis of CHANCE‐2

Author:

Wang Chunjuan1234ORCID,Jia Weili1ORCID,Jing Jing12ORCID,Meng Xia12,Wang Anxin12ORCID,Xu Qin12ORCID,Zhang Xinmiao12,Pan Yuesong12ORCID,Xie Xuewei12ORCID,Johnston S. Claiborne5ORCID,Bath Philip M.6ORCID,Lin Jinxi12ORCID,Jiang Yong12ORCID,Li Hao12,Wang Yilong12ORCID,Zhao Xingquan12ORCID,Liu Liping12ORCID,Li Zixiao12347ORCID,Wang Yongjun12837ORCID,

Affiliation:

1. Vascular Neurology, Department of Neurology Beijing Tiantan Hospital, Capital Medical University Beijing China

2. China National Clinical Research Center for Neurological Diseases Beijing Tiantan Hospital, Capital Medical University Beijing China

3. Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences Beijing China

4. National Center for Healthcare Quality Management in Neurological Diseases Beijing China

5. Dell Medical School University of Texas at Austin Austin TX USA

6. Stroke Trials Unit, Division of Clinical Neuroscience University of Nottingham Nottingham United Kingdom

7. Chinese Institute for Brain Research Beijing China

8. Advanced Innovation Center for Human Brain Protection Capital Medical University Beijing China

Abstract

Background This study aimed to investigate the efficacy and safety of ticagrelor–aspirin versus clopidogrel–aspirin in Chinese patients by the presence and clinical presentation of intracranial artery stenosis (ICAS) using randomized trial data from the CHANCE‐2 (Clopidogrel in High‐Risk Patients With Acute Nondisabling Cerebrovascular Events‐II) trial. Methods and Results A total of 6412 patients with minor stroke or transient ischemic attack who carried CYP2C19 loss‐of‐function alleles were randomized to either the ticagrelor–aspirin or clopidogrel–aspirin group. Patients without imaging of the intracranial artery were excluded from the nonprespecified subgroup analysis of CHANCE‐2. All patients included were classified into the following groups: without ICAS, symptomatic ICAS, or asymptomatic ICAS. The primary efficacy outcome was new strokes within 90 days. There were 5893 patients (median age, 64.8 years; 33.9% women) included, and 172 (4.9%), 171 (10.5%), and 57 (7.7%) cases of new strokes occurred within 90 days in the without ICAS, with symptomatic ICAS, and with asymptomatic ICAS groups, respectively. Ticagrelor–aspirin was associated with reduced risk of new stroke in patients without ICAS (62 [3.5%] versus 110 [6.3%]; hazard ratio [HR], 0.57 [95% CI, 0.41–0.78]) but not in those with symptomatic ICAS (HR, 0.77 [95% CI, 0.56–1.05]) or in those with asymptomatic ICAS (HR, 0.77 [95% CI, 0.43–1.38]) compared with clopidogrel–aspirin ( P for interaction=0.14). There were no significant differences in the proportion of severe or moderate bleeding events among different ICAS groups. Conclusions Patients without ICAS received a significantly greater benefit from ticagrelor–aspirin than clopidogrel–aspirin after minor ischemic stroke or transient ischemic attack, and there was no statistically significant difference between treatments in patients with symptomatic ICAS or asymptomatic ICAS. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04078737.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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