Risk factors for in-hospital nonhemorrhagic stroke in patients with acute myocardial infarction treated with thrombolysis results from GUSTO-I

• Published in: Circulation (New York, N.Y.) N.Y.), 1998-03, Vol.97 (8), p.757-764
• Main Authors: MAHAFFEY, K. W, GRANGER, C. B, CALIFF, R. M, SLOAN, M. A, THOMPSON, T. D, GORE, J. M, WEAVER, W. D, WHITE, H. D, SIMOONS, M. L, BARBASH, G. I, TOPOL, E. J
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Cardiac Catheterization; Cerebral Hemorrhage - complications; Cerebrovascular Disorders - chemically induced; Cerebrovascular Disorders - complications; Cerebrovascular Disorders - epidemiology; Coronary Artery Bypass; Female; Fibrinolytic Agents - therapeutic use; Follow-Up Studies; Humans; Inpatients; Male; Medical sciences; Middle Aged; Multivariate Analysis; Myocardial Infarction - complications; Myocardial Infarction - drug therapy; Pharmacology. Drug treatments; Prospective Studies; Risk Factors
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.CIR.97.8.757

Nonhemorrhagic stroke occurs in 0.1% to 1.3% of patients with acute myocardial infarction who are treated with thrombolysis, with substantial associated mortality and morbidity. Little is known about the risk factors for its occurrence. We studied the 247 patients with nonhemorrhagic stroke who were randomly assigned to one of four thrombolytic regimens within 6 hours of symptom onset in the GUSTO-I trial. We assessed the univariable and multivariable baseline risk factors for nonhemorrhagic stroke and created a scoring nomogram from the baseline multivariable modeling. We used time-dependent Cox modeling to determine multivariable in-hospital predictors of nonhemorrhagic stroke. Baseline and in-hospital predictors were then combined to determine the overall predictors of nonhemorrhagic stroke. Of the 247 patients, 42 (17%) died and another 98 (40%) were disabled by 30-day follow-up. Older age was the most important baseline clinical predictor of nonhemorrhagic stroke, followed by higher heart rate, history of stroke or transient ischemic attack, diabetes, previous angina, and history of hypertension. These factors remained statistically significant predictors in the combined model, along with worse Killip class, coronary angiography, bypass surgery, and atrial fibrillation/flutter. Nonhemorrhagic stroke is a serious event in patients with acute myocardial infarction who are treated with thrombolytic, antithrombin, and antiplatelet therapy. We developed a simple nomogram that can predict the risk of nonhemorrhagic stroke on the basis of baseline clinical characteristics. Prophylactic anticoagulation may be an important treatment strategy for patients with high probability for nonhemorrhagic stroke, but further study is needed.