IS VISIBLE INFARCTION ON COMPUTED-TOMOGRAPHY ASSOCIATED WITH AN ADVERSE PROGNOSIS IN ACUTE ISCHEMIC STROKE

Background and Purpose-It is unclear whether visible infarction on a C T scan at any time after the stroke is an adverse prognostic factor on ce other factors such as stroke severity are taken into consideration. We examined whether visible infarction was associated with a poor out come after stroke using univariate and multivariate analyses, includin g easily identifiable clinical baseline variables, and adjusting for t ime from stroke onset to CT. Methods-All inpatients and outpatients wi th an acute ischemic stroke attending our hospital stroke service were examined by a stroke physician and entered into a register prospectiv ely. The CT scan was coded prospectively for the site and size of any relevant recent visible infarct. The patients were followed up at 6 mo nths to ascertain their functional status with the use of the modified Rankin Scale. Analyses of the effect of visible infarction on the out comes ''dead or dependent'' or ''dead'' at 6 months were performed wit h adjustment for time from stroke to CT, clinical stroke type (lacunar , hemispheric, or posterior circulation), and in a multiple logistic r egression model to adjust for confounding baseline variables such as s troke severity. Results-In 993 patients in the stroke registry, visibl e 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 d ead (OR, 4.5; 95% CI, 2.7 to 7.5), both on its own and after adjustmen t for time from stroke to CT, stroke symptoms, and other important cli nical prognostic variables (OR for death or dependence in the predicti ve 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 ind icator (albeit of borderline significance) even after adjustment for s troke severity and time lapse between the stroke and the CT scan.