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Randomized Controlled Trial
. 2012 Feb;43(2):350-5.
doi: 10.1161/STROKEAHA.111.631739. Epub 2012 Jan 19.

Risk of recurrent stroke in patients with silent brain infarction in the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) imaging substudy

Ralph Weber  1 , Christian Weimar, Isabel Wanke, Claudia Möller-Hartmann, Elke R Gizewski, Jon Blatchford, Karin Hermansson, Andrew M Demchuk, Michael Forsting, Ralph L Sacco, Jeffrey L Saver, Steven Warach, Hans Christoph Diener, Anke Diehl; PRoFESS Imaging Substudy Group
Collaborators, Affiliations
Randomized Controlled Trial

Risk of recurrent stroke in patients with silent brain infarction in the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) imaging substudy

Ralph Weber et al. Stroke. 2012 Feb.

Abstract

Background and purpose: Silent brain infarctions are associated with an increased risk of stroke in healthy individuals. Risk of recurrent stroke in patients with both symptomatic and silent brain infarction (SBI) has only been investigated in patients with cardioembolic stroke in the European Atrial Fibrillation Trial. We assessed whether patients with recent noncardioembolic stroke and SBI detected on MRI are at increased risk for recurrent stroke, other cardiovascular events, and mortality.

Methods: The prevalence of SBI detected on MRI was assessed in 1014 patients enrolled in the imaging substudy of the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial. The primary outcome was first recurrence of stroke in patients with both symptomatic stroke and SBI in comparison with age- and sex-matched patients with stroke without SBI. Secondary outcomes were a combined vascular end point, other vascular events, and mortality. The 2 groups were compared using conditional logistic regression.

Results: Silent brain infarction was detected in 207 (20.4%) of the 1014 patients. Twenty-seven (13.0%) patients with SBI and 19 (9.2%) without SBI had a recurrent stroke (OR, 1.42; 95% CI, 0.79-2.56; P=0.24) during a mean follow-up of 2.5 years. Similarly, there was no statistically significant difference for all secondary outcome parameters between patients with SBI and matched patients without SBI.

Conclusions: The presence of SBI in patients with recent mild noncardioembolic ischemic stroke could not be shown to be an independent risk factor for recurrent stroke, other vascular events, or a higher mortality rate.

Clinical trial registration: URL: http://clinicaltrials.gov. Unique identifier: NCT00153062.

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Figures

Figure 1
Figure 1
Localization of 501 symptomatic and silent ischemic brain infarcts in 207 patients with presence of silent brain infarction on MRI.
Figure 2
Figure 2
Kaplan-Meier estimates of the time to first recurrent stroke in the 207 patients with evidence of silent brain infarction on MRI and 207 age and sex matched patients without silent brain infarction. Time point zero indicates the date of baseline MRI. No recurrent stroke occurred before baseline MRI.
See this image and copyright information in PMC

References

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