Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2021 Mar;6(1):80-86.
doi: 10.1136/svn-2020-000369. Epub 2020 Sep 21.

Association of elevated hs-CRP and multiple infarctions with outcomes of minor stroke or TIA: subgroup analysis of CHANCE randomised clinical trial

Guangyao Wang #  1   2 , Jing Jing #  1   2 , Jiejie Li  1   2 , Yuesong Pan  1   2 , Hongyi Yan  1   2 , Xia Meng  1   2 , Xingquan Zhao  1   2 , Liping Liu  1   2 , Hao Li  1   2 , David Z Wang  3 , Yongjun Wang  4 , Yilong Wang  4
Affiliations
Randomized Controlled Trial

Association of elevated hs-CRP and multiple infarctions with outcomes of minor stroke or TIA: subgroup analysis of CHANCE randomised clinical trial

Guangyao Wang et al. Stroke Vasc Neurol. 2021 Mar.

Abstract

Background and purpose: The relationship of high-sensitive C-reactive protein (hs-CRP) levels and infarction numbers with the prognosis of stroke is uncertain. This study evaluated the association of different hs-CRP levels and infarction numbers with the prognosis of acute minor ischaemic stroke or transient ischaemic attack (TIA).

Methods: A subset of 807 patients with both hs-CRP measurement and baseline MRI was included from the Clopidogrel in High-risk Patients with Acute Non-disabling Cerebrovascular Events trial. The primary efficacy outcome was the occurrence of an ischaemic stroke at the 1-year follow-up. Infarction numbers were classified as multiple acute infarctions (MAIs), single acute infarction and no acute infarction (NAI). The association between different hs-CRP levels with different infarction numbers and the risk of any outcome was analysed using multivariable Cox regression models.

Results: Among the 807 patients, 84 (10.4%) patients had a recurrent ischaemic stroke within 1 year. After adjustment for conventional confounding factors, patients with both elevated hs-CRP levels and MAIs were associated with approximately 4.7-fold of risk of ischaemic stroke within 1 year (16.7% vs 3.5%, HR 4.68, 95% CI 1.54 to 14.23, p=0.007), compared with those with non-elevated hs-CRP levels and NAI. Similar results were observed for the composite events.

Conclusions: Combined elevated hs-CRP levels and MAIs may increase 1-year stroke risk stratification efficiency in patients with minor ischaemic stroke or TIA compared with using those markers alone, which indicated that the combination of inflammatory and imaging markers might improve the effectiveness of risk stratification concerning minor ischaemic stroke or TIA.ClinicalTrials.gov Registry (NCT00979589).

Keywords: MRI; inflammation; stroke.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Cumulative probability of recurrent ischaemic stroke for patients by the status of hs-CRP levels and infarction numbers. Hs-CRP, high-sensitive C-reactive protein; MAIs, multiple acute infarctions; NAI, no acute infarction; SAI, single acute infarction.
See this image and copyright information in PMC

References

    1. Coull AJ, Lovett JK, Rothwell PM, et al. . Population based study of early risk of stroke after transient ischaemic attack or minor stroke: implications for public education and organisation of services. BMJ 2004;328:326. 10.1136/bmj.37991.635266.44 - DOI - PMC - PubMed
    1. Johnston SC, Gress DR, Browner WS, et al. . Short-term prognosis after emergency department diagnosis of TIA. JAMA 2000;284:2901–6. 10.1001/jama.284.22.2901 - DOI - PubMed
    1. Yang Y, Zhou M, Zhong X, et al. . Dual versus mono antiplatelet therapy for acute non-cardioembolic ischaemic stroke or transient ischaemic attack: a systematic review and meta-analysis. Stroke Vasc Neurol 2018;3:107–16. 10.1136/svn-2018-000168 - DOI - PMC - PubMed
    1. Wang Y, Wang Y, Zhao X, et al. . Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med 2013;369:11–19. 10.1056/NEJMoa1215340 - DOI - PubMed
    1. Johnston SC, Rothwell PM, Nguyen-Huynh MN, et al. . Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet 2007;369:283–92. 10.1016/S0140-6736(07)60150-0 - DOI - PubMed

Publication types

MeSH terms

Substances

Associated data