White matter hyperintensity load on stroke recurrence and mortality at 1 year after ischemic stroke

ObjectiveTo define the role and risks associated with white matter hyperintensity (WMH) load in a stroke population with respect to recurrent stroke and mortality after ischemic stroke.MethodsA total of 7,101 patients at a network of university hospitals presenting with ischemic strokes were followed up for 1 year. Multivariable Cox proportional hazards model and competing risk analysis were used to examine the independent association between quartiles of WMH load and stroke recurrence and mortality at 1 year.ResultsOverall recurrent stroke risk at 1 year was 6.7%/y, divided between 5.6%/y for recurrent ischemic and 0.5%/y for recurrent hemorrhagic strokes. There was a stronger association between WMH volume and recurrent hemorrhagic stroke by quartile (hazard ratio [HR] 7.32, 14.12, and 33.52, respectively) than for ischemic recurrence (HR 1.03, 1.37, and 1.61, respectively), but the absolute incidence of ischemic recurrence by quartile was higher (3.8%/y, 4.5%/y, 6.3%/y, and 8.2%/y by quartiles) vs hemorrhagic recurrence (0.1%/y, 0.4%/y, 0.6%/y, and 1.3%/y). All-cause mortality (10.5%) showed a marked association with WMH volume (HR 1.06, 1.46, and 1.60), but this was attributable to nonvascular rather than vascular causes.ConclusionsThere is an association between WMH volume load and stroke recurrence, and this association is stronger for hemorrhagic than for ischemic stroke, although the absolute risk of ischemic recurrence remains higher. These data should be helpful to practitioners seeking to find the optimal preventive/treatment regimen for poststroke patients and to individualize risk-benefit ratios.

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One-Year Risk of Recurrent Stroke and Death Associated with Vertebrobasilar Artery Stenosis and Occlusion in a Cohort of 10,515 Patients

Cerebrovascular Diseases ◽

10.1159/000495418 ◽

2019 ◽

Vol 47 (1-2) ◽

pp. 40-47 ◽

Cited By ~ 3

Author(s):

Adnan I. Qureshi ◽

Mushtaq H. Qureshi ◽

Li-Ming Lien ◽

Jiunn-Tay Lee ◽

Jiann-Shing Jeng ◽

...

Keyword(s):

Ischemic Stroke ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Recurrent Stroke ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Large Artery ◽

Stroke Registry ◽

Risk Of Death ◽

Vertebrobasilar Artery

Background: The natural history of vertebrobasilar artery (VBA) stenosis or occlusion remains understudied. Methods: Patients with diagnosis of ischemic stroke or transient ischemic attack (TIA) who were noted to have VBA stenosis based on computed tomography or magnetic resonance imaging or catheter-based angiogram were selected from Taiwan Stroke Registry. Cox proportional hazards model was used to determine the hazards ratio (HR) of recurrent stroke and death within 1 year of index event in various groups based on severity of VBA stenosis (none to mild: 0–49%; moderate to severe: 50–99%: occlusion: 100%) after adjusting for differences in demographic and clinical characteristics between groups at baseline evaluation. Results: None to mild or moderate to severe VBA stenosis was diagnosed in 6972 (66%) and 3,137 (29.8%) among 10,515 patients, respectively, and occlusion was identified in 406 (3.8%) patients. Comparing with patients who showed none to mild stenosis of VBA, there was a significantly higher risk of recurrent stroke (HR 1.21, 95% CI 1.01–1.45) among patients with moderate to severe VBA stenosis. There was a nonsignificantly higher risk of recurrent stroke (HR 1.49, 95% CI 0.99–2.22) and significantly higher risk of death (HR 2.21, 95% CI 1.72–2.83), among patients with VBA occlusion after adjustment of potential confounders. Conclusions: VBA stenosis or occlusion was relatively prevalent among patients with TIA or ischemic stroke and associated with higher risk of recurrent stroke and death in patients with ischemic stroke or TIA who had large artery atherosclerosis.

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Anticoagulation and Risk of Stroke Recurrence in Patients with Embolic Stroke of Undetermined Source Having No Potential Source of Embolism

Cerebrovascular Diseases ◽

10.1159/000510773 ◽

2020 ◽

Vol 49 (6) ◽

pp. 601-608

Author(s):

Noriko Sato ◽

Ryu Matsuo ◽

Fumi Kiyuna ◽

Kuniyuki Nakamura ◽

Jun Hata ◽

...

Keyword(s):

Ischemic Stroke ◽

Proportional Hazards Model ◽

Recurrent Stroke ◽

Oral Anticoagulants ◽

Anticoagulation Therapy ◽

Cox Proportional Hazards Model ◽

Embolic Stroke ◽

Stroke Recurrence ◽

Potential Source ◽

Reduced Risk

Background: This study aimed to determine whether use of oral anticoagulants (OACs) was associated with a reduced risk of recurrent stroke compared with use of antiplatelets (APs) in patients with embolic stroke of undetermined source (ESUS) having no potential source of embolism. Methods: Of 8,790 patients with acute ischemic stroke registered at 7 centers in the Fukuoka Stroke Registry from June 2007 to May 2017, we included 681 patients (mean age 69.7 [SD 14.1] years, 48.3% men) who experienced ESUS without a potential source of embolism and received OAC alone or AP alone. We estimated hazard ratios (HRs) and 95% confidential intervals (CIs) of recurrent ischemic stroke or any stroke after discharge using a Cox proportional hazards model and Fine and Gray model. Results: During a mean follow-up of 3.4 (SD 1.7) years, event rates of recurrent ischemic stroke were 4.4 per 100 person-years in 489 patients treated with AP and 2.0 per 100 person-years in 192 patients treated with OAC. OAC use was associated with a reduced risk of recurrent ischemic stroke, even after adjusting for potential confounding factors (multivariable-adjusted HR [95% CI], 0.42 [0.23–0.80]) and when additionally considering death as a competing risk (0.45 [0.24–0.85]). The reduced risk of recurrent ischemic stroke was still observed in patients treated with OAC (0.32 [0.15–0.67]) in reference to propensity score-matched patients treated with AP. These associations were maintained for all types of stroke, including ischemic and hemorrhagic stroke. Conclusions: This nonrandomized observational study suggests that anticoagulation therapy might be associated with a reduced risk of recurrent stroke compared with antiplatelet therapy in patients with ESUS in whom no potential source of embolism was identified. Further study should be performed in consideration of a potential source of embolism even in patients with ESUS.

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Abstract P592: Admission Hyperglycemia is Associated With Subsequent Ischemic Stroke After Transient Ischemic Attack or Minor Stroke: A Secondary Analysis of the POINT Trial

Stroke ◽

10.1161/str.52.suppl_1.p592 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Brian C Mac Grory ◽

Shadi Yaghi ◽

Shreyansh Shah ◽

Pratik Y Chhatbar ◽

Carmelo Graffagnino ◽

...

Keyword(s):

Ischemic Stroke ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Sensitivity Analyses ◽

Minor Stroke ◽

Stroke Recurrence ◽

Diabetic Patients ◽

Lesion Volume ◽

Minor Ischemic Stroke

Introduction: Hyperglycemia is associated with increased lesion volume and worse functional outcome after acute ischemic stroke, however, it is not known whether it is associated with further cerebrovascular events. The aim of this study was to examine the association between admission hyperglycemia and subsequent ischemic stroke. Methods: This was an exploratory analysis of the Platelet Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trial, which compared combined clopidogrel/aspirin with aspirin alone with respect to the primary outcome of subsequent ischemic stroke, myocardial infarction, or vascular death. We dichotomized patients based on a serum glucose threshold of 180mg/dl (chosen a priori based on the upper boundary of the active control arm of SHINE). We calculated hazard ratios (HR) for subsequent ischemic stroke at 90 days via a Cox proportional hazards model adjusting for age, sex, study treatment assignment and vascular risk factors. We performed sensitivity analyses excluding patients with a known history of diabetes and in patients whose index event was a TIA vs. minor stroke. Results: Of 4,878 patients in this analysis (mean age 64.6 years), 594 (12.2%) were hyperglycemic on presentation and 267 (5.5%) had a subsequent ischemic stroke within 90 days. Admission hyperglycemia was associated with subsequent ischemic stroke (HR 1.88; 95% CI:1.39-2.53, p<0.01). This association persisted after adjustment for relevant covariates (aHR 1.86, 95% CI: 1.37-2.52, p<0.01), in non-diabetic patients (n=3,529, aHR 3.1, 95% CI:1.7-5.7, p<0.01), in patients with TIA (n=2,327, aHR 2.2, 95% CI: 1.2-4.1, p<0.01), and in patients with minor ischemic stroke (n=2,304, aHR = 1.5, 95% CI: 1.1-2.2, p=0.02). Conclusions: Hyperglycemia portends a higher risk of subsequent ischemic stroke after adjusting for known predictors of stroke recurrence. This study may provide further support to pursuing aggressive secondary prevention strategies in this population.

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Long-term proton pump inhibitors and risk of gastric cancer development after treatment for Helicobacter pylori: a population-based study

Gut ◽

10.1136/gutjnl-2017-314605 ◽

2017 ◽

Vol 67 (1) ◽

pp. 28-35 ◽

Cited By ~ 161

Author(s):

Ka Shing Cheung ◽

Esther W Chan ◽

Angel Y S Wong ◽

Lijia Chen ◽

Ian C K Wong ◽

...

Keyword(s):

Gastric Cancer ◽

Helicobacter Pylori ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Proportional Hazards Model ◽

Absolute Risk ◽

Eradication Therapy ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model

ObjectiveProton pump inhibitors (PPIs) is associated with worsening of gastric atrophy, particularly in Helicobacter pylori (HP)-infected subjects. We determined the association between PPIs use and gastric cancer (GC) among HP-infected subjects who had received HP therapy.DesignsThis study was based on a territory-wide health database of Hong Kong. We identified adults who had received an outpatient prescription of clarithromycin-based triple therapy between year 2003 and 2012. Patients who failed this regimen, and those diagnosed to have GC within 12 months after HP therapy, or gastric ulcer after therapy were excluded. Prescriptions of PPIs or histamine-2 receptor antagonists (H2RA) started within 6 months before GC were excluded to avoid protopathic bias. We evaluated GC risk with PPIs by Cox proportional hazards model with propensity score adjustment. H2RA was used as a negative control exposure.ResultAmong the 63 397 eligible subjects, 153 (0.24%) developed GC during a median follow-up of 7.6 years. PPIs use was associated with an increased GC risk (HR 2.44, 95% CI 1.42 to 4.20), while H2RA was not (HR 0.72, 95% CI 0.48 to 1.07). The risk increased with duration of PPIs use (HR 5.04, 95% CI 1.23 to 20.61; 6.65, 95% CI 1.62 to 27.26 and 8.34, 95% CI 2.02 to 34.41 for ≥1 year, ≥2 years and ≥3 years, respectively). The adjusted absolute risk difference for PPIs versus non-PPIs use was 4.29 excess GC (95% CI 1.25 to 9.54) per 10 000 person-years.ConclusionLong-term use of PPIs was still associated with an increased GC risk in subjects even after HP eradication therapy.

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Abstract P670: Obesity and Mortality After the First Ischemic Stroke: Is Obesity Paradox Real?

Stroke ◽

10.1161/str.52.suppl_1.p670 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Durgesh Chaudhary ◽

Ayesha Khan ◽

Mudit Gupta ◽

Yirui Hu ◽

Jiang Li ◽

...

Keyword(s):

Ischemic Stroke ◽

Proportional Hazards Model ◽

Obesity Paradox ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Obese Patients ◽

Stroke Patients ◽

Stroke Event ◽

One Year ◽

First Time

Introduction: Obesity is an established risk factor for ischemic stroke but the association of increased body mass index (BMI) with survival after ischemic stroke remains controversial. Many studies have shown that increased BMI has a “protective” effect on survival after stroke while other studies have debunked the obesity paradox. This study aimed at examining the relationship between BMI and all-cause mortality at one year in first-time ischemic stroke patients using data extracted from different resources including electronic health records. Methods: We analyzed consecutive ischemic stroke patients captured in the Geisinger NeuroScience Ischemic Stroke (GNSIS) database. Survival in first-time ischemic stroke patients was analyzed using Kaplan-Meier estimator, stratified by different BMI categories. The predictors of mortality at one-year were assessed using a multivariate Cox proportional hazards model. Results: Among 6,703 first-time adult ischemic stroke patients, mean age was 70.2 ±13.5 years and 52% were men. Of these patients, 24% patients were non-overweight (BMI < 25), 34% were overweight (BMI 25-29.9) and 41% were obese (BMI ≥ 30). One-year survival probability was significantly higher in overweight patients (87%, 95% CI: [85.6 - 88.4], p<0.001) and obese patients (89.5%, 95% CI: [88.4 - 90.7], p<0.001) compared to non-overweight patients (78.1%, 95% CI: [76.0 - 80.1]). In multivariate analysis, one-year mortality was significantly lower in overweight and obese patients (overweight patients- HR = 0.61 [95% CI, 0.52 - 0.72]; obese patients- HR = 0.56 [95% CI, 0.48 - 0.67]). Other significant predictors of one-year mortality were age at the ischemic stroke event (HR = 1.04 [95% CI, 1.03 - 1.04]), history of neoplasm (HR = 1.59 [95% CI, 1.38 - 1.85]), atrial fibrillation or flutter (HR = 1.26 [95% CI, 1.09 - 1.46]), heart failure (HR = 1.68 [95% CI, 1.42 - 1.98]), diabetes mellitus (HR = 1.27 [95% CI, 1.1 - 1.47]), rheumatic disease (HR = 1.37 [95% CI, 1.05 - 1.78]) and myocardial infarction ((HR = 1.23 [95% CI, 1.02 - 1.48]). Conclusion: Our results support the obesity paradox in ischemic stroke patients as shown by a significantly decreased hazard ratio for one-year mortality among overweight and obese patients in comparison to non-overweight patients.

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Premature Ventricular Complexes on Screening Electrocardiogram and Risk of Ischemic Stroke

Stroke ◽

10.1161/strokeaha.114.008447 ◽

2015 ◽

Vol 46 (5) ◽

pp. 1365-1367 ◽

Cited By ~ 7

Author(s):

Sunil K. Agarwal ◽

Jennifer Chao ◽

Frederick Peace ◽

Suzanne E. Judd ◽

Brett Kissela ◽

...

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Racial Differences ◽

Proportional Hazards Model ◽

Geographic Region ◽

Left Ventricular ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Premature Ventricular Complexes ◽

Increased Risk

Background and Purpose— Premature ventricular complexes (PVCs) detected from long-term ECG recordings have been associated with an increased risk of ischemic stroke. Whether PVCs seen on routine ECG, commonly used in clinical practice, are associated with an increased risk of ischemic stroke remains unstudied. Methods— This analysis included 24 460 participants (aged, 64.5+9.3 years; 55.1% women; 40.0% blacks) from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study who were free of stroke at the time of enrollment. PVCs were ascertained from baseline ECG (2003–2007), and incident stroke cases through 2011 were confirmed by an adjudication committee. Results— A total of 1415 (5.8%) participants had at least 1 PVC at baseline, and 591 developed incident ischemic stroke during an average (SD) follow-up of 6.0 (2.0) years. In a cox proportional hazards model adjusted for age, sex, race, geographic region, education, previous heart disease, systolic blood pressure, blood pressure–lowering medications, current smoking, diabetes mellitus, left ventricular hypertrophy by ECG, and aspirin use and warfarin use, the presence of PVCs was associated with 38% increased risk of ischemic stroke (hazard ratio [95% confidence interval], 1.38 [1.05–1.81]). Conclusions— PVCs are common on routine screening ECGs and are associated with an increased risk of ischemic stroke.

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Abstract 60: National Temporal Patterns in Recurrent Stroke by Demographic Characteristics and Geographic Regions: 2001-2016

Stroke ◽

10.1161/str.52.suppl_1.60 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Judith H Lichtman ◽

Erica C Leifheit ◽

Yun Wang ◽

Larry B Goldstein

Keyword(s):

Proportional Hazards Model ◽

Recurrent Stroke ◽

Temporal Trends ◽

Healthcare Delivery ◽

Temporal Patterns ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Fee For Service ◽

The Us ◽

Over Time

Background: There have been important advances in secondary stroke prevention and a focus on healthcare delivery in the US over the past two decades. Yet, little is known about temporal patterns of recurrent stroke in the US. We examined temporal trends in recurrent stroke by sociodemographic characteristics and geographic areas using national Medicare data. Methods: We included fee-for-service Medicare beneficiaries aged ≥65y with a primary discharge diagnosis of ischemic stroke from 2001 to 2016. We fit a Cox proportional hazards model that censored for change in Medicare enrollment and accounted for death to evaluate the temporal trend in 1-year recurrent stroke, adjusting for demographic and clinical factors. Models were repeated for subgroups defined by age, sex, race, and state. We mapped smoothed rates of 1-year recurrent stroke by county to assess geographic variation over time. Results: There were 3,485,618 unique beneficiaries discharged with stroke during the study period. Demographic and clinical characteristics remained relatively stable over time, but the proportions discharged with home health services and inpatient rehabilitation increased. The observed 1-year recurrent stroke rate decreased from 11.2% in 2001-2004 to 9.3% in 2013-2016, with an adjusted annual reduction in recurrence from 2001-2016 of 1.49% (95% CI 1.40%-1.58%). There were significant reductions for all age, sex, and race groups (A). Geographic areas with persistently high rates were identified over time (B). In state-stratified analysis, the annual percentage reduction in recurrence ranged from -1.2% to 2.5% and was significant for all but 12 states. Conclusions: Recurrent strokes decreased over time overall and by sociodemographic subgroups; however, we identified geographic areas with persistently high recurrence rates. Such findings can target secondary prevention intervention opportunities for high-risk populations and communities.

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White Matter Hyperintensity Predicts Early Ischemic Stroke Recurrence (S19.006)

Neurology ◽

10.1212/wnl.78.1_meetingabstracts.s19.006 ◽

2012 ◽

Vol 78 (Meeting Abstracts 1) ◽

pp. S19.006-S19.006

Author(s):

G.-M. Kim ◽

E. M. Arsava ◽

J. Helenius ◽

A. Y. Hakan

Keyword(s):

Ischemic Stroke ◽

White Matter ◽

White Matter Hyperintensity ◽

Stroke Recurrence

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Abstract P291: Anger Expression and Risk of Stroke Subtypes: The Circulatory Risk in Communities Study (CIRCS)

Circulation ◽

10.1161/circ.125.suppl_10.ap291 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Tetsuya Ohira ◽

Takeshi Tanigawa ◽

Hironori Imano ◽

Akihiko Kitamura ◽

Masahiko Kiyama ◽

...

Keyword(s):

Ischemic Stroke ◽

Hemorrhagic Stroke ◽

Proportional Hazards Model ◽

Statistical Significance ◽

Anger Expression ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Adjusted Relative Risk ◽

Stroke Subtypes ◽

Increased Risk

Background: Previous studies have reported that anger expression style is associated with cardiovascular disease and its risk factors. Epidemiologic data regarding the association between anger expression and risk of stroke have been inconsistent, and few studies have reported the association of anger expression with stroke subtypes. Hypothesis: We assessed the hypothesis that suppressed anger is associated with increased risk of stroke, and the associations vary by stroke subtype. Methods: A prospective study of Japanese subjects aged 30–74 years was undertaken using data collected from 6,276 participants (2,285 men and 3,991 women) in cardiovascular risk surveys conducted in four communities between 1995 and 1998. We used the Spielberger Anger Expression Scale to measure self-reported levels of anger expression style; anger expressed outwardly is regarded as “anger-out” and anger held in or suppressed is classified as “anger-in.” The incidence of stroke was ascertained by systematic surveillance. The hazard ratios (HRs) of incidence of stroke and its subtypes and 95% confidence intervals (CI) relative to the lowest tertile of anger expression were calculated with adjustment for age and other potential confounding factors using the Cox proportional hazards model. Results: During an average follow up of 9.1-years, 129 incident strokes (50 hemorrhagic, 77 ischemic, and 2 unclassified strokes) occurred. Men with “anger-in” scores in the highest tertile had a 1.7-fold multivariable-adjusted relative risk of stroke as compared with those in the lowest tertile, but it did not reach statistical significance (HR; 1.73, 95% CI; 0.94–3.19, p=0.08). When stratifying for stroke subtypes, the associations between “anger-in” and stroke tended to be stronger for hemorrhagic stroke than ischemic stroke; HRs (95% CI) were 3.82 (1.03–14.1) for hemorrhagic stroke and 1.32 (0.64–2.71) for ischemic stroke. Anger-in score was not associated with incidence of either hemorrhagic or ischemic stroke in women. In men and women, there were no significant associations between “anger-out” and incidence of stroke. As compared with the lowest tertile of “anger-out” scores, the multivariable-adjusted HRs of stroke for the highest tertile of “anger-out” scores were 1.39 (0.74–2.59) for men and 1.48 (0.78–2.78) for women, respectively. Conclusions: Suppressed anger may be associated with increased risk of hemorrhagic stroke among middle-aged Japanese men, but not women.

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Abstract 16688: Effects of Evolocumab in Patients With Prior Percutaneous Coronary Intervention: An Analysis From the Fourier Trial

Circulation ◽

10.1161/circ.142.suppl_3.16688 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Remo H Furtado ◽

Antonio A Fagundes ◽

Kazuma Oyama ◽

Thomas A Zelniker ◽

Minao Tang ◽

...

Keyword(s):

Statin Therapy ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Absolute Risk ◽

Coronary Revascularization ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Atherosclerotic Cardiovascular Disease ◽

History Of ◽

Coronary Events

Introduction: Among patients with atherosclerotic cardiovascular disease (ASCVD), those with history of PCI represent an important population for potential high risk for cardiovascular (CV) events. We examined the clinical efficacy of the PCSK9 inibitor evolocumab in patients with prior PCI. Methods: FOURIER randomized 27,564 patients with ASCVD on statin therapy to evolocumab or placebo with a median follow-up of 2.2 yrs. The primary end point (PEP) was the composite of CV death, MI, stroke, unstable angina, or coronary revascularization; major coronary events were the composite of coronary death, MI, or coronary revascularization. The risk of events in patients with and without a history of PCI were compared in the placebo arm. The clinical benefit of evolocumab vs. placebo was compared using a Cox proportional hazards model. Results: 17,073 (62%) patients had prior PCI at baseline. Among patients in the placebo arm, those with prior PCI (N=8563) had a 1.6x higher rate of the PEP (16.8 vs 10.7%; adjusted HR 1.61; 95% CI 1.42-1.84 P<0.0001) and nearly double the rate of major coronary events (14.5 vs. 7.8%; P<0.0001; adjusted HR 1.72; 95% CI 1.49-1.99; Figure left). In patients with prior PCI, evolocumab reduced the risk of the PEP by 16% (HR 0.84; 95% CI 0.77-0.91; P<0.0001) and of major coronary events by 18% (HR 0.82; 95% CI 0.75-0.90, P<0.0001; Figure right), including a 30% reduction in fatal or non-fatal MI (P<0.001) and a 24% reduction in coronary revascularization (P<0.001). After the first year, there was a 25% reduction in major coronary events (HR 0.75, 95% CI 0.66-0.86, P<0.0001). The absolute risk reduction at 3 years with evolocumab for major coronary events was 2.8% in patients with prior PCI vs. 0.3% in those without. Conclusions: In a contemporary cohort with ASCVD on statin therapy, patients with prior PCI were at heightened risk for coronary events. Evolocumab was highly effective in this group, reducing major coronary events by 18% with a NNT at 3 years of only 36.

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