J Neurol Neurosurg Psychiatry 74:452-458 doi:10.1136/jnnp.74.4.452
  • Paper

Visible infarction on computed tomography is an independent predictor of poor functional outcome after stroke, and not of haemorrhagic transformation

  1. J M Wardlaw1,
  2. T M West3,
  3. P A G Sandercock1,
  4. S C Lewis1,
  5. O Mielke2,
  6. for The International Stroke Trials Collaborative Group
  1. 1Department of Clinical Neurosciences, University of Edinburgh, UK
  2. 2Department of Neurology, Universitätsklinikum Mannheim, University of Heidelberg, Germany
  3. 3Biostatistics, Green Lane Hospital, Auckland, New Zealand
  1. Correspondence to:
 Professor J M Wardlaw, Department of Clinical Neurosciences, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK; 
  • Received 27 May 2002
  • Accepted 28 November 2002
  • Revised 21 November 2002


Objectives: 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.


  • Competing interests: none declared.

  • See Editorial Commentary 413

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