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From the Department of Clinical Neurosciences, Western General Hospital
NHS Trust, Edinburgh, Scotland.
Correspondence to Dr J. Wardlaw, Department of Clinical Neurosciences, Western General Hospital NHS Trust, Bramwell Dott Building, Crewe Rd, Edinburgh EH4 2XU, UK. E-mail jmw{at}skull.dcn.ed.ac.uk
Background and Purpose—It is unclear
whether visible infarction on a CT scan at any time after the stroke is
an adverse prognostic factor once other factors such as stroke severity
are taken into consideration. We examined whether visible infarction
was associated with a poor outcome after stroke using
univariate and multivariate
analyses, including easily identifiable clinical baseline
variables, and adjusting for time from stroke onset to CT.
Methods—All inpatients and outpatients with an acute
ischemic stroke attending our hospital stroke service were
examined by a stroke physician and entered into a register
prospectively. The CT scan was coded prospectively for the site and
size of any relevant recent visible infarct. The patients were followed
up at 6 months to ascertain their functional status with the use of the
modified Rankin Scale. Analyses of the effect of visible
infarction on the outcomes "dead or dependent" or "dead" at 6
months were performed with adjustment for time from stroke to CT,
clinical stroke type (lacunar, hemispheric, or posterior circulation),
and in a multiple logistic regression model to adjust for confounding
baseline variables such as stroke severity.
Results—In 993 patients in the stroke registry, visible
infarction increased the risk of being dead or dependent at 6 months
(odds ratio [OR], 2.5; 95% confidence interval [CI], 1.9 to 3.3)
or dead (OR, 4.5; 95% CI, 2.7 to 7.5), both on its own and after
adjustment for time from stroke to CT, stroke symptoms, and other
important clinical prognostic variables (OR for death or dependence
in the predictive model, 1.5; 95% CI, 1.0 to 2.0; OR for death, 2.4;
95% CI, 1.4 to 4.1).
Conclusions—Visible infarction on CT is an adverse prognostic
indicator (albeit of borderline significance) even after adjustment for
stroke severity and time lapse between the stroke and the CT scan.
© 1998 American Heart Association, Inc.
Original Contributions
Is Visible Infarction on Computed Tomography Associated With an Adverse Prognosis in Acute Ischemic Stroke?
Key Words: cerebral infarction • cerebrovascular disorders • prognosis • stroke assessment • stroke outcome • tomography, x-ray computed
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