Abstract W P370: Acute Ischemic Stroke In Acute Myocardial Infarction Patients Receiving Iv Rt-pa: An Analysis Of Thrombolysis In Myocardial Infarction (timi) Ii Trial
Background: Increased platelet activation is observed during acute myocardial infarction (MI) and further increased by administration of recombinant tissue plasminogen activator (rt-PA).
Methods: We analyzed data from 3,339 patients between the ages of 18 and 75 years who received intravenous rt-PA within 4 hours of the onset of MI and were randomly assigned to an invasive strategy or a conservative strategy in TIMI II trial. We ascertained the occurrence of ischemic stroke within 72 hours of randomization and associated outcomes.
Results: A total of 8 (0.23%) of 3331 patients suffered an ischemic stroke within 72 hours. The mean age (±SD) was 64.4 years (±6.3) and 7 were men. The proportion of patients who developed cardiogenic shock (37.5% versus 5.3%, p<0.0001) and renal failure (12.5% versus 1.7%, p=0.02) was higher among those who developed ischemic stroke. There was no difference in the rate of subsequent invasive strategy in those who developed ischemic stroke (50.0% versus 50.3%, p=0.9). The occurrence of intracranial hemorrhage (37.5% versus 0.7%, p<0.0001) and in hospital mortality (37.5% versus 4.8%, p<0.0001) was significantly higher among patients who developed ischemic stroke compared those who were stroke free.
Conclusions: Ischemic stroke in the immediate period following IV rt-PA for MI is rare but associated with very high rates of intracranial hemorrhage and in hospital mortality.
Author Disclosures: N. Jahangir: None. A.A. Malik: None. M. Afzal: None. M.H. Qureshi: None. A.I. Qureshi: None.
- © 2015 by American Heart Association, Inc.