Visible infarction on computed tomography is an independent predictor of poor functional outcome after stroke, and not of haemorrhagic transformation.
OBJECTIVE
To examine a very large dataset to provide a robust answer to the question of whether visible infarction on computed tomography was (a) an independent predictor of functional outcome at all times up to 48 hours after stroke, and (b) independently associated with haemorrhagic transformation, with or without antithrombotic treatment.


METHODS
The study assessed associations between visible infarction, time to randomisation, baseline neurological deficit, stroke syndrome, allocated aspirin or heparin treatment, recurrent haemorrhagic stroke, early death and six month functional outcome in the International Stroke Trial.


RESULTS
Of 12 550 patients, 6267 (50%) had visible infarction up to 48 hours after stroke. The prevalence of visible infarction increased with increasing time from onset and extent of the stroke syndrome. Visible infarction was independently associated with increased death within 14 days (odds ratio (OR) 1.17, 95% CI 1.02 to 1.35), and of death or dependency at six months (OR 1.42, 95% CI 1.31 to 1.55), an absolute increase of 13%, or 130 per 1000 more dead or dependent patients with visible infarction than without it. There was no significant independent relation between visible infarction and fatal or non-fatal haemorrhagic transformation, or interaction between visible infarction and aspirin or heparin treatment allocation with six month functional outcome.


CONCLUSIONS
Visible infarction on computed tomography up to 48 hours after stroke is an independent adverse prognostic sign.
Wardlaw
J M
JM
Department of Clinical Neurosciences, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, Scotland, UK. jmw@skull.dcn.ed.ac.uk
West
T M
TM
Sandercock
P A G
PA
Lewis
S C
SC
Mielke
O
O
D000368:Aged; D001241:Aspirin / Q000627:therapeutic use; D020520:Brain Infarction / Q000150:complications* / Q000000981:diagnostic imaging* / Q000628:therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D020300:Intracranial Hemorrhages / Q000150:complications* / Q000000981:diagnostic imaging* / Q000628:therapy; D008297:Male; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D011897:Random Allocation; D020127:Recovery of Function; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000628:therapy; D013997:Time Factors; D014057:Tomography, X-Ray Computed
D005343:Fibrinolytic Agents; D006493:Heparin; D001241:Aspirin