Portal de Periódicos da CAPES

Incidence, risk factors, and clinical outcome of stroke after acute myocardial infarction in clinical practice

2001; Elsevier BV; Volume: 87; Issue: 6 Linguagem: Inglês

10.1016/s0002-9149(00)01505-8

1879-1913

Harm Wienbergen, Rudolf Schiele, Anselm K. Gitt, Steffen Schneider, Tobias Heer, Martin Gottwik, Ulf Gieseler, Michael A. Weber, C. Müller, J. Neubaur, Jochen Senges,

Acute Ischemic Stroke Management

Stroke after acute myocardial infarction (AMI) occurs because of severe cerebral ischemia or hemorrhage. In many randomized studies, the risk of cerebral hemorrhage after thrombolysis has been investigated. 1 GUSTO Angiographic InvestigatorsThe effects of tissue plasminogen activator, streptokinase, or both on coronary-artery patency, ventricular function, and survival after acute myocardial infarction. N Engl J Med. 1993; 329: 1615-1622 Crossref PubMed Scopus (1879) Google Scholar , 2 ISIS-2 Collaborative GroupRandomised trial of intravenous streptokinase, oral aspirin, both or neither among 17,187 cases of suspected acute myocardial infarction ISIS-2. Lancet. 1988; 2: 349-360 PubMed Google Scholar , 3 ISIS-3 Collaborative GroupA randomised comparison of streptokinase versus tissue plasminogen activator versus anistreplase and of aspirin plus heparin versus aspirin alone among 41,299 cases of suspected acute myocardial infarction. Lancet. 1992; 339: 753-770 Abstract PubMed Scopus (1141) Google Scholar , 4 Lopez Bescos L. Calades O'Callaghan A. Castro-Beiras A. Kallmeyer Martin C. Martin-Jadraque L. Garcia-Dorado D. Cruz Fernandez J.M. Incidence of vascular stroke in patients with acute myocardial infarction receiving fibrinolytic treatment. Eur Heart J. 1999; 1: F19-F23 Google Scholar , 5 Maggioni A.P. Franzosi M.G. Farina M.I. Santoro E. Celani M.G. Ricci S. Tognoni G. Cerebrovascular events after myocardial infarction analysis of the GISSI trial. Br Med J. 1991; 302: 1428-1431 Crossref PubMed Google Scholar , 6 Maggioni A.P. Franzosi M.G. Santoro E. White H. Van de Werf F. Tognoni G. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico II (GISSI-2), and the International Study GroupThe risk of stroke in patients with acute myocardial infarction after thrombolytic and antithrombotic treatment. N Engl J Med. 1992; 327: 1-6 Crossref PubMed Scopus (221) Google Scholar , 7 Califf R.M. Topol E.J. George B.S. Boswick J.M. Abbottsmith C. Sigmon K.N. Candela R. Masek R. Kereiakes D. O'Neill W.W. Stack R.S. Stump D. Hemorrhagic complications associated with the use of intravenous tissue plasminogen activator in treatment of acute myocardial infarction. Am J Med. 1988; 85: 353-359 Abstract Full Text PDF PubMed Scopus (127) Google Scholar , 8 Gore J.M. Sloan M. Price T.R. Randall A.M.Y. Bovill E. Collen D. Forman S. Knatterud G.L. Sopko G. Terrin M.L. TIMI InvestigatorsIntracerebral hemorrhage, cerebral infarction and subdural hematoma after acute myocardial infarction and thrombolytic therapy in the thrombolysis in myocardial infarction study. Circulation. 1991; 83: 448-459 Crossref PubMed Scopus (299) Google Scholar , 9 Fibrinolytic Therapy Trialists' (FTT) Collaborative GroupIndications for fibrinolytic therapy in suspected acute myocardial infarction collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Lancet. 1994; 343: 311-322 Abstract PubMed Scopus (2798) Google Scholar In an analysis of randomized trials of the Fibrinolytic Therapy Trialists' collaborative group, 1 GUSTO Angiographic InvestigatorsThe effects of tissue plasminogen activator, streptokinase, or both on coronary-artery patency, ventricular function, and survival after acute myocardial infarction. N Engl J Med. 1993; 329: 1615-1622 Crossref PubMed Scopus (1879) Google Scholar the incidence of strokes after thrombolysis was 1.2% in the first 35 days after admission; 0.4% were hemorrhage, 0.8% were ischemic strokes or of unknown etiology. 9 Fibrinolytic Therapy Trialists' (FTT) Collaborative GroupIndications for fibrinolytic therapy in suspected acute myocardial infarction collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Lancet. 1994; 343: 311-322 Abstract PubMed Scopus (2798) Google Scholar The total incidence of strokes after AMI, including patients without thrombolysis, was 1.0%. 9 Fibrinolytic Therapy Trialists' (FTT) Collaborative GroupIndications for fibrinolytic therapy in suspected acute myocardial infarction collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Lancet. 1994; 343: 311-322 Abstract PubMed Scopus (2798) Google Scholar In the National Registry of Myocardial Infarction-2, an incidence of stroke of 1.3% after AMI was found; 0.4% were cerebral bleeding. 10 Becker R.C. Burns M. Gore J.M. Spencer F.A. Ball S.P. French W. Lambrew C. Bowlby L. Hilbe J. Rogers W.J. National Registry of Myocardial Infarction (NRMI-2) ParticipantsEarly assessment and in-hospital management of patients with acute myocardial infarction at increased risk for adverse outcomes a nationwide perspective of current clinical practice. Am Heart J. 1998; 135: 786-796 Abstract Full Text Full Text PDF PubMed Scopus (66) Google Scholar It has been shown that the risk of ischemic and hemorrhagic strokes after AMI strongly depends on individual risk factors as age and comorbidity of patients. 11 Simoons M.L. Maggioni A.P. Knatterud G. Leimberger J.D. de Jaegere P. van Domburg R. Boersma E. Franzosi M.G. Califf R. Schröder R. Braunwald E. Individual risk assessment for intracranial haemorrhage during thrombolytic therapy. Lancet. 1993; 342: 1523-1528 Abstract PubMed Scopus (265) Google Scholar , 12 Mahaffey K.W. Granger C.B. Sloan A.M. Thompson T.D. Gore J.M. Weaver D. White H.D. Simoons M.L. Barbash G.I. Topol E. Califf R.M. Risk factors for in-hospital nonhemorrhagic stroke in patients with acute myocardial infarction treated with thrombolysis. Circulation. 1998; 97: 757-764 Crossref PubMed Scopus (64) Google Scholar We investigated patients with hemorrhagic and ischemic strokes after AMI in a large patient population of unselected consecutively included patients with AMI in the German Myocardial Infarction Registry (MIR) and Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) registry. We analyzed incidence, risk factors, and mortality in 21,330 patients with AMI.