Risk of recurrent stroke in patients with silent brain infarction in the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) imaging substudy
Ralph Weber, 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, Conrado Estol, Miguel Garrote, María Esnaola y Rojas, Sebastián Ameriso, Raúl Rey, Pablo Leonardo Ioli, Juan José Cirio, Gustavo Angel Saredo, Christopher Bladin, Stephen Davis, David Howse, James Scott, Jaime Silva, Xiaojiang Sun, Ling Miao, Wei Li, Liying Cui, Haibo Chen, Weiwei Zhang, Lijuan Wang, En Xu, Qing Di, Yan Liu, Jörg Glahn, Dietmar Schneider, Peter Ringleb, Wolfgang Steinke, Lutz Harms, Andreas Hetzel, Michael Rosenkranz, Carlos Cantu, Jorge Villarreal, Byung Woo Yoon, Byung Chul Lee, Ki Hyun Cho, Ji Hoe Heo, Joung Ho Rha, Hyo Suk Nam, Sun Uck Kwon, Sien-Tsong Chen, Jiann-Shing Jeng, Helen L Po, Ming-Hong Chang, Ku-Chou Chang, Li-Ming Lien, Chung Y Hsu, Clinton Wright, Daniel Hanley, Jeffery Kramer, Donald Tamulonis, Joseph Weissman, Bret Haake, Steve Moon, Scott Silliman, Pierre Fayad, Erfan Albakri, Ralph Weber, 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, Conrado Estol, Miguel Garrote, María Esnaola y Rojas, Sebastián Ameriso, Raúl Rey, Pablo Leonardo Ioli, Juan José Cirio, Gustavo Angel Saredo, Christopher Bladin, Stephen Davis, David Howse, James Scott, Jaime Silva, Xiaojiang Sun, Ling Miao, Wei Li, Liying Cui, Haibo Chen, Weiwei Zhang, Lijuan Wang, En Xu, Qing Di, Yan Liu, Jörg Glahn, Dietmar Schneider, Peter Ringleb, Wolfgang Steinke, Lutz Harms, Andreas Hetzel, Michael Rosenkranz, Carlos Cantu, Jorge Villarreal, Byung Woo Yoon, Byung Chul Lee, Ki Hyun Cho, Ji Hoe Heo, Joung Ho Rha, Hyo Suk Nam, Sun Uck Kwon, Sien-Tsong Chen, Jiann-Shing Jeng, Helen L Po, Ming-Hong Chang, Ku-Chou Chang, Li-Ming Lien, Chung Y Hsu, Clinton Wright, Daniel Hanley, Jeffery Kramer, Donald Tamulonis, Joseph Weissman, Bret Haake, Steve Moon, Scott Silliman, Pierre Fayad, Erfan Albakri
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: https://ichgcp.net/clinical-trials-registry/NCT00153062" title="See in ClinicalTrials.gov">NCT00153062.
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Source: PubMed