title: Lower incidence of cerebral infarction correlates with improved functional outcome after aneurysmal subarachnoid hemorrhage.
abstract: Despite an undisputed association between vasospasm and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage (SAH), there is debate if this association implies causality. It has been suggested that cerebral infarction is a better outcome measure than vasospasm in clinical trials and observational studies. To further investigate the relationship between infarction and outcome, we performed a systematic review and meta-analysis of all randomized, double-blind, placebo-controlled trials that studied the efficacy of pharmaceutical preventive strategies in SAH patients, and had both cerebral infarction and clinical outcome as outcome events. Effect sizes were expressed in (pooled) risk ratio (RR) estimates with corresponding 95% confidence intervals (CIs). Sensitivity analyses were performed for studies with a low risk of bias and for those who reported outcome at 3 months after SAH. Twenty-four studies including 8,552 patients were included. Pharmaceutical treatments decreased the incidence of both cerebral infarction (RR: 0.83; 95% CI: 0.74 to 0.93) and of poor functional outcome (RR: 0.92; 95% CI: 0.86 to 0.98). The sensitivity analyses did not change the results essentially. These data suggest that the previously observed association between cerebral infarction and functional outcome implies causality, and that cerebral infarction is a better outcome measure than vasospasm in clinical trials and observational studies.
authors.affiliation: Department of Experimental Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. m.d.vergouwen@amc.uva.nl
authors.forename: Mervyn D I
authors.initials: MD
authors.lastname: Vergouwen
authors.forename: Nima
authors.initials: N
authors.lastname: Etminan
authors.forename: Don
authors.initials: D
authors.lastname: Ilodigwe
authors.forename: R Loch
authors.initials: RL
authors.lastname: Macdonald
mesh_terms: D002544:Cerebral Infarction / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D016032:Randomized Controlled Trials as Topic; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000517:prevention & control*