Risk of Recurrent Stroke in Patients With Silent Brain Infarction in the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) Imaging Substudy

Author:

Weber Ralph1,Weimar Christian1,Wanke Isabel1,Möller-Hartmann Claudia1,Gizewski Elke R.1,Blatchford Jon1,Hermansson Karin1,Demchuk Andrew M.1,Forsting Michael1,Sacco Ralph L.1,Saver Jeffrey L.1,Warach Steven1,Diener Hans Christoph1,Diehl Anke1,

Affiliation:

1. From the Department of Neurology (R.W., C.W., H.C.D.) and Neuroradiology (I.W., C.M.-H., E.R.G., M.F., A.D.), University of Duisburg-Essen, Essen, Germany; Boehringer Ingelheim–Ltd (J.B.), Bracknell, UK; Boehringer Ingelheim AB (K.H.), Stockholm, Sweden; the Departments of Clinical Neurosciences (A.M.D.), Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; the Department of Neurology (R.L.S.), Miller School of Medicine, University of Miami, Miami, FL; the Stroke Center and...

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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialised Nursing,Cardiology and Cardiovascular Medicine,Clinical Neurology

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