title: Risk of recurrent stroke in patients with silent brain infarction in the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) imaging substudy.
abstract: OBJECTIVE
  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.
  
  
  BACKGROUND
  URL: http://clinicaltrials.gov. Unique identifier: NCT00153062.
authors.affiliation: Department of Neurology, University Duisburg-Essen, Essen, Germany.
authors.forename: Ralph
authors.initials: R
authors.lastname: Weber
authors.forename: Christian
authors.initials: C
authors.lastname: Weimar
authors.forename: Isabel
authors.initials: I
authors.lastname: Wanke
authors.forename: Claudia
authors.initials: C
authors.lastname: Möller-Hartmann
authors.forename: Elke R
authors.initials: ER
authors.lastname: Gizewski
authors.forename: Jon
authors.initials: J
authors.lastname: Blatchford
authors.forename: Karin
authors.initials: K
authors.lastname: Hermansson
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Demchuk
authors.forename: Michael
authors.initials: M
authors.lastname: Forsting
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
authors.forename: Steven
authors.initials: S
authors.lastname: Warach
authors.forename: Hans Christoph
authors.initials: HC
authors.lastname: Diener
authors.forename: Anke
authors.initials: A
authors.lastname: Diehl
mesh_terms: D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D001562:Benzimidazoles / Q000627:therapeutic use; D001565:Benzoates / Q000627:therapeutic use; D002545:Brain Ischemia / Q000150:complications / Q000473:pathology; D002544:Cerebral Infarction / Q000150:complications* / Q000473:pathology; D000077144:Clopidogrel; D004176:Dipyridamole / Q000627:therapeutic use; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000150:complications / Q000453:epidemiology / Q000473:pathology; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012307:Risk Factors; D055502:Secondary Prevention; D012959:Socioeconomic Factors; D020521:Stroke / Q000188:drug therapy / Q000473:pathology / Q000517:prevention & control*; D000077333:Telmisartan; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D001562:Benzimidazoles; D001565:Benzoates; D010975:Platelet Aggregation Inhibitors; D014665:Vasodilator Agents; D004176:Dipyridamole; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin; D000077333:Telmisartan