Stroke: carotid bruit, cardiomegaly, peripheral vascular disease and increased age increased the risk of a death or stroke.

Clinical bottom line (level 1b)

  1. A third of patients with a retinal infarct died within a mean of 4.2 years, a tenth had a stroke, a fifth had a coronary event and a third had either a stroke, MI or vascular death.
  2. Patients with a retinal infarct were at an increased risk of dying at a mean of 4.2 years, if they had: peripheral vascular disease, have cardiomegaly, carotid bruit or with increasing age.
  3. Patents were at an increased risk of a stroke if they had a carotid bruit or with increasing age.
  4. Patients are at increased risk of a coronary event, if they had cardiomegaly, carotid bruit or increasing age.
Hankey et al: British Journal of Medicine 1991; 302: 499-504
Expires June 2003

The study

Inception cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: university hospital departments of clinical neurology

98 patients (aged mean 64 years, 56% male) retinal infarction without prior stroke- presumed atheromatous arterial thromboembolism or cardiogenic embolism

Excluded if
  • temporal arteritis



    • Factors studied:
  • death, stroke, coronary event and stroke, MI or vascular death
  • peripheral vascular disease
  • cardiomegaly
  • carotid bruit
  • age (10 year interval)
  • carotid bruit
  • age (10 year interval)
  • cardiomegaly
  • carotid bruit
  • age (10 year interval)
  • carotid bruit
  • cardiomegaly
  • age (10 year interval)




    • A computerised biomedical data package based on the stepwise Cox's proportional hazards regression model, was used to adjust for confounding factors.

    100% followed for 1 to 10 years (mean 4.2 years)
    Outcomes studied:
  • death
  • any stroke
  • coronary events
  • stroke, MI or vascular death

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    death 1 to 10 years (mean 4.2 years) 29/98 29.6%
    (20.6% to 38.6%)
    any stroke 1 to 10 years (mean 4.2 years) 10/98 10.2%
    (4.21% to 16.2%)
    coronary events 1 to 10 years (mean 4.2 years) 19/98 19.4%
    (11.6% to 27.2%)
    stroke, MI or vascular death 1 to 10 years (mean 4.2 years) 30/98 30.6%
    (21.5% to 39.7%)

    prognostic factor for
    death     		time to outcome control rate (%) adjusted OR
    (95% CI)    		 NNF+
    (95% CI)
    peripheral vascular disease 4 years 13/98
    (13.3%)     		5.20
    (2.10 to 13.3)     		3
    (2 to 9)
    cardiomegaly 4 years 16/98
    (16.3%)     		5.70
    (2.10 to 15.5)     		3
    (2 to 8)
    carotid bruit 4 years 31/98
    (31.6%)     		4.30
    (1.70 to 11.0)     		3
    (2 to 8)
    age (10 year interval) ? 1.10
    (0.90 to 1.60)

    prognostic factor for
    any stroke     		time to outcome control rate (%) adjusted OR
    (95% CI)    		 NNF+
    (95% CI)
    carotid bruit 4 years 31/98
    (31.6%)     		5.10
    (1.30 to 20.0)     		3
    (2 to 17)
    age (10 year interval) ? 1.90
    (0.80 to 4.80)

    prognostic factor for
    coronary events     		time to outcome control rate (%) adjusted OR
    (95% CI)    		 NNF+
    (95% CI)
    cardiomegaly 4 years 16/98
    (16.3%)     		3.60
    (1.30 to 10.0)     		4
    (2 to 26)
    carotid bruit 4 years 31/98
    (31.6%)     		2.80
    (1.10 to 7.30)     		4
    (2 to 48)
    age (10 year interval) ? 1.50
    (0.80 to 2.80)

    prognostic factor for
    stroke, MI or vascular death     		time to outcome control rate (%) adjusted OR
    (95% CI)    		 NNF+
    (95% CI)
    carotid bruit 4 years 31/98
    (31.6%)     		3.20
    (1.50 to 7.10)     		4
    (2 to 11)
    cardiomegaly 4 years 16/98
    (16.3%)     		2.80
    (1.20 to 6.30)     		5
    (3 to 38)
    age (10 year interval) ? 1.50
    (0.90 to 2.50)

    Comments

    1. At some stage during follow-up, 37 patients were taking aspirin and 8 were treated with oral anticoagulants; 13 had carotid endarterectomy, 1 had coronary artery bypass surgery, 5 had cardiac valve surgery and 2 had peripheral vascular surgery.
    2. Few patients experienced contralateral retinal infarction

    Citation

    1. Hankey GJ, Slattery JM, Warlow CP: Prognosis and prognostic factors of retinal infarction: a prospective cohort study. British Journal of Medicine 1991; 302: 499-504
    Search Terms: stroke in Best Evidence
    Contributor: Nick Shenker and Clare Wotton, November 1999
    Reviewer: Sylvie Antonini-Revaz

    Clinical Question.
    Patient retinal infarction
    Intervention or Exposure presence of prognostic factors
    Comparison absence of factors
    Outcome death