Waters MF et al. Factors associated with recurrent ischemic stroke in the Medical Group of the SAMMPRIS trial JAMA Neurology 73:3 2016 pp.308-315
Endpoint: stroke or death within 30 days, stroke in appropriate arterial territory after 30 days.
Overall, risk of a primary endpoint was half of what was expected based on WASID or other studies.The highest risk features are prior stroke in the territory of the stenotic artery, stroke as the qualifying event, and absent statin use at time of enrollment. TRENDS occurred based on risk of higher degree of stenosis and presence of diabetes mellitus. In WASID, degree of stenosis stratified risk with more risk with higher degree of artery stenosis. The risk in WASID of stroke was 18 % in 70-79 %, but 31 % in 80-89%. The groups were not analyzed separately in WASID, above is post hoc. In Sammpris, only patients 70-99 % were enrolled, and the risk was 19 % with greater than 80 % stenosis, and 12 % with 70-79 % stenosis.
For diabetics in Sammpris, diabetics reached an endpoint at a rate of 18 % v. 10 % for nondiabetics.
By artery, the intracranial carotid had a risk of an endpoint of 23 %. The VA and BA wer 9.3 and (.5 % respectively. By gender, risk for women was 20.1 per cent, 10.7 % for men.
The risk factors for periprocedural stroke had little overlap, the main ones being in that arm being older age, nonsmoking status, diabetes and BA stenosis.
Patients in medical group with TIA alone had LOW risk at one and two years of 5.6 and 7 % respectively.
Exercise during followup was the most important determinant of outcome in the medical arm.
Overall the risk of the medical arm in SAMMPRIS was 15 percent at 32 months.
