{"title":"小后循环缺血性卒中的PCISOS风险分布分层异质性结果：CHANCE-2试验的事后分析","authors":"Xiaoyu Lin, Cang Guo, Xia Meng, Xingquan Zhao, Hao Li, Yongjun Wang, Jialei Yang","doi":"10.1161/STROKEAHA.125.053054","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Risk stratification in posterior circulation ischemic stroke (PCIS) is challenging. Although the Posterior Circulation Ischemic Stroke Outcome Score (PCISOS) was developed to address this, its utility in minor PCIS and in identifying homogeneous populations for clinical trials or treatment-responsive subgroups remains uncertain.</p><p><strong>Methods: </strong>CHANCE-2 (Clopidogrel in High-Risk Patients With Acute Non-disabling Cerebrovascular Events-II) was a multicenter, randomized trial that enrolled patients with minor stroke or high-risk transient ischemic attack who carried CYP2C19 loss-of-function alleles. Patients received ticagrelor-aspirin or clopidogrel-aspirin. This secondary analysis included patients with PCIS, stratified into low- (≤15), intermediate- (16-20), and high-risk (≥21) groups based on PCISOS. The primary outcome was 90-day stroke recurrence. Outcomes were analyzed using Cox and logistic regression models, adjusting for significantly imbalanced baseline covariates relevant to each comparison.</p><p><strong>Results: </strong>Among 1379 patients with PCIS (median age, 64.0 [56.6-70.7] years; 67.4% male), 90-day stroke recurrence occurred in 6.0%, 8.2%, and 18.5% of the low-, intermediate-, and high-risk PCISOS groups, respectively (<i>P</i><0.001). Risk increased progressively (adjusted hazard ratios for intermediate-risk, 1.32 [95% CI, 0.87-2.02]; high-risk, adjusted hazard ratio, 3.02 [95% CI, 1.52-6.02]; <i>P</i><sub>trend</sub>=0.008). Similar associations were observed for modified Rankin Scale (mRS) score of 2 to 6 outcomes (adjusted odds ratio for intermediate-risk, 2.21 [95% CI, 1.28-3.84]; high-risk, 3.53 [95% CI, 1.42-8.74]; <i>P</i><sub>trend</sub><0.001). A treatment-by-risk interaction was observed: ticagrelor-aspirin reduced the modified Rankin Scale score of 1 to 6 rates in low- and intermediate-risk patients, but not in high-risk patients (<i>P</i><sub>interaction</sub>=0.03). Favorable outcome (modified Rankin Scale score of 0-1) was more common in patients with PCISOS ≤15 than in those with National Institutes of Health Stroke Scale score ≤3 (<i>P</i>=0.02).</p><p><strong>Conclusions: </strong>PCISOS provides effective risk stratification in minor PCIS, identifying subgroups with heterogeneous outcome risks and differential response to ticagrelor-aspirin. Patients with PCISOS ≥21, a high-risk subgroup within National Institutes of Health Stroke Scale-defined minor strokes, remain underexplored and may benefit from tailored strategies in future trials. A threshold of PCISOS ≤15 may more accurately define truly low-risk patients than National Institutes of Health Stroke Scale score ≤3, thereby improving trial efficiency and advancing precision in PCIS research.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT04078737.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":8.9000,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"PCISOS Risk Profiles Stratify Heterogeneous Outcomes in Minor Posterior Circulation Ischemic Stroke: A Post Hoc Analysis of the CHANCE-2 Trial.\",\"authors\":\"Xiaoyu Lin, Cang Guo, Xia Meng, Xingquan Zhao, Hao Li, Yongjun Wang, Jialei Yang\",\"doi\":\"10.1161/STROKEAHA.125.053054\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Risk stratification in posterior circulation ischemic stroke (PCIS) is challenging. Although the Posterior Circulation Ischemic Stroke Outcome Score (PCISOS) was developed to address this, its utility in minor PCIS and in identifying homogeneous populations for clinical trials or treatment-responsive subgroups remains uncertain.</p><p><strong>Methods: </strong>CHANCE-2 (Clopidogrel in High-Risk Patients With Acute Non-disabling Cerebrovascular Events-II) was a multicenter, randomized trial that enrolled patients with minor stroke or high-risk transient ischemic attack who carried CYP2C19 loss-of-function alleles. Patients received ticagrelor-aspirin or clopidogrel-aspirin. This secondary analysis included patients with PCIS, stratified into low- (≤15), intermediate- (16-20), and high-risk (≥21) groups based on PCISOS. The primary outcome was 90-day stroke recurrence. Outcomes were analyzed using Cox and logistic regression models, adjusting for significantly imbalanced baseline covariates relevant to each comparison.</p><p><strong>Results: </strong>Among 1379 patients with PCIS (median age, 64.0 [56.6-70.7] years; 67.4% male), 90-day stroke recurrence occurred in 6.0%, 8.2%, and 18.5% of the low-, intermediate-, and high-risk PCISOS groups, respectively (<i>P</i><0.001). Risk increased progressively (adjusted hazard ratios for intermediate-risk, 1.32 [95% CI, 0.87-2.02]; high-risk, adjusted hazard ratio, 3.02 [95% CI, 1.52-6.02]; <i>P</i><sub>trend</sub>=0.008). Similar associations were observed for modified Rankin Scale (mRS) score of 2 to 6 outcomes (adjusted odds ratio for intermediate-risk, 2.21 [95% CI, 1.28-3.84]; high-risk, 3.53 [95% CI, 1.42-8.74]; <i>P</i><sub>trend</sub><0.001). A treatment-by-risk interaction was observed: ticagrelor-aspirin reduced the modified Rankin Scale score of 1 to 6 rates in low- and intermediate-risk patients, but not in high-risk patients (<i>P</i><sub>interaction</sub>=0.03). Favorable outcome (modified Rankin Scale score of 0-1) was more common in patients with PCISOS ≤15 than in those with National Institutes of Health Stroke Scale score ≤3 (<i>P</i>=0.02).</p><p><strong>Conclusions: </strong>PCISOS provides effective risk stratification in minor PCIS, identifying subgroups with heterogeneous outcome risks and differential response to ticagrelor-aspirin. Patients with PCISOS ≥21, a high-risk subgroup within National Institutes of Health Stroke Scale-defined minor strokes, remain underexplored and may benefit from tailored strategies in future trials. A threshold of PCISOS ≤15 may more accurately define truly low-risk patients than National Institutes of Health Stroke Scale score ≤3, thereby improving trial efficiency and advancing precision in PCIS research.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT04078737.</p>\",\"PeriodicalId\":21989,\"journal\":{\"name\":\"Stroke\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":8.9000,\"publicationDate\":\"2025-09-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Stroke\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1161/STROKEAHA.125.053054\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Stroke","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/STROKEAHA.125.053054","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
PCISOS Risk Profiles Stratify Heterogeneous Outcomes in Minor Posterior Circulation Ischemic Stroke: A Post Hoc Analysis of the CHANCE-2 Trial.
Background: Risk stratification in posterior circulation ischemic stroke (PCIS) is challenging. Although the Posterior Circulation Ischemic Stroke Outcome Score (PCISOS) was developed to address this, its utility in minor PCIS and in identifying homogeneous populations for clinical trials or treatment-responsive subgroups remains uncertain.
Methods: CHANCE-2 (Clopidogrel in High-Risk Patients With Acute Non-disabling Cerebrovascular Events-II) was a multicenter, randomized trial that enrolled patients with minor stroke or high-risk transient ischemic attack who carried CYP2C19 loss-of-function alleles. Patients received ticagrelor-aspirin or clopidogrel-aspirin. This secondary analysis included patients with PCIS, stratified into low- (≤15), intermediate- (16-20), and high-risk (≥21) groups based on PCISOS. The primary outcome was 90-day stroke recurrence. Outcomes were analyzed using Cox and logistic regression models, adjusting for significantly imbalanced baseline covariates relevant to each comparison.
Results: Among 1379 patients with PCIS (median age, 64.0 [56.6-70.7] years; 67.4% male), 90-day stroke recurrence occurred in 6.0%, 8.2%, and 18.5% of the low-, intermediate-, and high-risk PCISOS groups, respectively (P<0.001). Risk increased progressively (adjusted hazard ratios for intermediate-risk, 1.32 [95% CI, 0.87-2.02]; high-risk, adjusted hazard ratio, 3.02 [95% CI, 1.52-6.02]; Ptrend=0.008). Similar associations were observed for modified Rankin Scale (mRS) score of 2 to 6 outcomes (adjusted odds ratio for intermediate-risk, 2.21 [95% CI, 1.28-3.84]; high-risk, 3.53 [95% CI, 1.42-8.74]; Ptrend<0.001). A treatment-by-risk interaction was observed: ticagrelor-aspirin reduced the modified Rankin Scale score of 1 to 6 rates in low- and intermediate-risk patients, but not in high-risk patients (Pinteraction=0.03). Favorable outcome (modified Rankin Scale score of 0-1) was more common in patients with PCISOS ≤15 than in those with National Institutes of Health Stroke Scale score ≤3 (P=0.02).
Conclusions: PCISOS provides effective risk stratification in minor PCIS, identifying subgroups with heterogeneous outcome risks and differential response to ticagrelor-aspirin. Patients with PCISOS ≥21, a high-risk subgroup within National Institutes of Health Stroke Scale-defined minor strokes, remain underexplored and may benefit from tailored strategies in future trials. A threshold of PCISOS ≤15 may more accurately define truly low-risk patients than National Institutes of Health Stroke Scale score ≤3, thereby improving trial efficiency and advancing precision in PCIS research.
期刊介绍：
Stroke is a monthly publication that collates reports of clinical and basic investigation of any aspect of the cerebral circulation and its diseases. The publication covers a wide range of disciplines including anesthesiology, critical care medicine, epidemiology, internal medicine, neurology, neuro-ophthalmology, neuropathology, neuropsychology, neurosurgery, nuclear medicine, nursing, radiology, rehabilitation, speech pathology, vascular physiology, and vascular surgery.
The audience of Stroke includes neurologists, basic scientists, cardiologists, vascular surgeons, internists, interventionalists, neurosurgeons, nurses, and physiatrists.
Stroke is indexed in Biological Abstracts, BIOSIS, CAB Abstracts, Chemical Abstracts, CINAHL, Current Contents, Embase, MEDLINE, and Science Citation Index Expanded.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
