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Wang A, Meng X, Tian X, Zuo Y, Bath PM, Li H, Xie X, Jing J, Lin J, Wang Y, Zhao X, Liu L, Li Z, Jiang Y, Xu J, Wang F, Chen W, Cao M, Li J, Wang Y. Ticagrelor Aspirin vs Clopidogrel Aspirin in CYP2C19 Loss-of-Function Carriers With Minor Stroke or TIA Stratified by Risk Profile. Neurology 2023; 100:e497-e504. [PMID: 36535779 PMCID: PMC9931078 DOI: 10.1212/wnl.0000000000201454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 09/08/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Genotype data of the Clopidogrel with Aspirin in Acute Minor Stroke or Transient Ischemic Attack (CHANCE) trial showed that efficacy of clopidogrel aspirin depended on CYP2C19 genotype and risk profile. A stratification of patients who carried CYP2C19 loss-of-function (LOF) alleles according to the risk of recurrent stroke may be important for selecting optimal antiplatelet therapy. We aimed to compare the efficacy and safety of ticagrelor aspirin with clopidogrel aspirin in CYP2C19 LOF carriers with minor stroke or transient ischemic attack (TIA) stratified by risk profile. METHODS Data were obtained from Ticagrelor or Clopidogrel with Aspirin in High-Risk Patients with Acute Nondisabling Cerebrovascular Events II (CHANCE-2) trial. Low-risk and high-risk profiles were defined by Essen Stroke Risk Score (ESRS) (<3 [low risk] and ≥3 [high risk], respectively). RESULTS A total of 6,412 CYP2C19 LOF carriers were enrolled; ticagrelor aspirin was associated with a reduced risk of primary outcome (new stroke within 90-day follow-up) in patients at low risk (hazard ratio [HR], 0.65; 95% CI, 0.48-0.82), but not in those at high risk (HR, 0.97; 95% CI, 0.73-1.29), compared with clopidogrel aspirin (p = 0.02 for interaction). Secondary outcomes generally went in the same direction as the primary outcome. The primary safety outcome of severe or moderate bleeding did not differ based on risk profile (p = 0.24 for interaction), although the incidence of total bleeding was greater with ticagrelor aspirin than with clopidogrel aspirin among patients at low risk (p < 0.01 for interaction). Analysis in the per-protocol population yielded similar results. DISCUSSION This post hoc analysis of CHANCE-2 trial showed that CYP2C19 LOF carriers with minor stroke or TIA at low risk of recurrent stroke received a greater benefit from ticagrelor aspirin than from clopidogrel aspirin. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that CYP2C19 LOF carriers with minor stroke or TIA at low risk, but not at high risk, of recurrent stroke (by the ESRS) received a greater benefit from ticagrelor aspirin than from clopidogrel aspirin. TRIAL REGISTRATION INFORMATION URL: www. CLINICALTRIALS gov. Unique identifier: NCT04078737.
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Affiliation(s)
- Anxin Wang
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Xia Meng
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Xue Tian
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Yingting Zuo
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Philip M Bath
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Hao Li
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Xuewei Xie
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Jing Jing
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Jinxi Lin
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Yilong Wang
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Xingquan Zhao
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Liping Liu
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Zixiao Li
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Yong Jiang
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Jie Xu
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Feng Wang
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Weifeng Chen
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Minghua Cao
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Jianhua Li
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Yongjun Wang
- From the Department of Neurology (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases (A.W., X.M., X.T., Y.Z., H.L., X.X., J.J., J.L., Y.W., X.Z., L.L., Z.L., Y.J., J.X., Y.W.), Beijing, China; Department of Epidemiology and Health Statistics (X.T.), School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology (X.T.), China; Stroke Trials Unit, Mental Health & Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; Departments of Neurology (F.W.), Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Neurology (W.C.), Xingyang People's Hospital, Henan, China; Department of Neurology (M.C.), Jingdezheng First People's Hospital, Jiangxi, China; Department of Neurology (J.L.), The First Hospital of Fangshan District, Beijing, China; Advanced Innovation Center for Human Brain Protection (A.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China.
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