Treatment and Outcome of Patients With Acute Myocardial Infarction and Prior Cerebrovascular Events in the Thrombolytic EraThe Israeli Thrombolytic National Survey

Autor: Leonardo Reisin, Solomon Behar, Valentina Boyko, Alon Marmor, Benyamin Peled, David Tanne, Abraham Palant, A. Caspi, Shmuel Gottlieb, Tiberio Rosenfeld, Jonathan Balkin, Hanoch Hod
Rok vydání: 1998
Předmět:
Zdroj: Archives of Internal Medicine. 158:601
ISSN: 0003-9926
DOI: 10.1001/archinte.158.6.601
Popis: Background Patients with a history of stroke presenting with acute myocardial infarction (MI) are often excluded from thrombolytic therapy owing to fear of intracranial hemorrhage. Few data, however, are available on the risks vs the benefits of thrombolysis in patients with an acute MI and a prior cerebrovascular event (PCE). Methods Data were derived from 2 nationwide surveys of 2012 consecutive patients with acute MI admitted to all 25 coronary care units in Israel during 1992 and 1994. Thrombolytic therapy was given to patients with a PCE at the discretion of the treating physicians. Outcomes were compared between patients with an acute MI with and without a PCE and between patients with a PCE treated with or excluded from thrombolysis. Results Patients with a PCE (n=115 [6%]) were older, with higher rates of atherosclerotic risk factors and in-hospital complications than their counterparts without a prior event (n=1897). They were treated less often with thrombolysis or mechanical reperfusion. The 1-year mortality rates were higher among patients with a PCE (28% vs 19%, P Conclusions These findings, derived from 2 nationwide surveys of consecutive patients with acute MI, suggest that patients with PCEs have an adverse outcome attributed to their older age and less favorable risk profile. Thrombolytic therapy, however, based on our preliminary data, may be beneficial in selected patients with an acute MI with a nonrecent PCE.
Databáze: OpenAIRE