Homocysteine Level Predicts Response to Dual Antiplatelet in Women With Minor Stroke or Transient Ischemic Attack Subanalysis of the CHANCE Trial
Homocysteine Level Predicts Response to Dual Antiplatelet in Women With Minor Stroke or Transient Ischemic Attack Subanalysis of the CHANCE Trial
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DOI：
10.1161/atvbaha.119.313741
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发表时间：
2020-03-01
影响因子：
8.7
通讯作者：
Wang, Yongjun
中科院分区：
文献类型：
--
作者：
Li, Jiejie;Wang, Yilong;Wang, Yongjun
目的：探讨同型半胱氨酸水平与男性和女性患者双重抗血小板治疗的疗效和安全性的关系。方法和结果：机会审判（氯吡格雷在急性非致残性脑血管事件高危患者中的应用）从2009年10月1日至7月30日，将急性轻微缺血性卒中或高危短暂性脑缺血发作患者随机分配至氯吡格雷加阿司匹林组或阿司匹林单药组，2012年，在中国。分析了来自73个（64%）预先指定的临床研究中心的3044例基线同型半胱氨酸水平连续患者的亚组。参与者按性别分组。主要结局为90天内卒中复发。次要结局包括复合血管事件和独立生存或死亡。安全性结局为任何出血。采用考克斯比例风险模型评估同型半胱氨酸水平与随机抗血小板治疗对疗效和安全性结局的相互作用。在调整混杂因素后，女性患者的同型半胱氨酸水平和随机抗血小板治疗之间存在显著的相互作用（P=0.010），但男性患者的作用不明显（P=0.595）。与单独使用阿司匹林相比，氯吡格雷联合阿司匹林显著降低了同型半胱氨酸水平不升高的女性患者的复发性卒中风险（校正风险比，0.459 [95%CI，0.271-0.776]; P=0.004）。这种益处在同型半胱氨酸水平升高的女性患者中消失。没有显着的相互作用功能的结果或出血率observed.CONCLUSIONS：同型半胱氨酸可能是一个潜在的生物标志物来区分双重和单一的抗血小板治疗的影响，在女性患者轻微缺血性中风或高风险短暂性脑缺血发作。
OBJECTIVES: To investigate the relationship of homocysteine levels with the efficacy and safety of dual antiplatelet therapy in female and male patients.APPROACH AND RESULTS: The CHANCE trial (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events) randomized patients with acute minor ischemic stroke or high-risk transient ischemic attack to clopidogrel plus aspirin or aspirin alone from October 1, 2009, to July 30, 2012, in China. A subgroup of 3044 consecutive patients with baseline homocysteine levels from 73 (64%) prespecified clinical sites was analyzed. Participants were grouped by sex. Primary outcome was stroke recurrence within 90 days. Secondary outcomes consisted of composite vascular events and independent living or death. Safety outcome was any bleeding. Cox proportional-hazards models were used to assess the interaction of homocysteine levels with randomized antiplatelet therapy on efficacy and safety outcomes. A significant interaction between homocysteine levels and the randomized antiplatelet therapies was found on recurrent stroke after adjustment for confounding factors in women (P=0.010) but not in men (P=0.595). Compared with aspirin alone, clopidogrel plus aspirin significantly reduced the risk of recurrent stroke in women without elevated homocysteine levels (adjusted hazard ratio, 0.459 [95% CI, 0.271-0.776]; P=0.004). Such benefit disappeared in female patients with increased homocysteine level. No significant interaction on functional outcome or bleeding rate was observed.CONCLUSIONS: Homocysteine could be a potential biomarker to discriminate the effects of dual and single antiplatelet therapy in female patients with minor ischemic stroke or high-risk transient ischemic attack.