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From the Duke Clinical Research Institute, Durham, North Carolina
(K.W.M., C.B.G., T.D.T., R.M.C.); University of Maryland School of Medicine,
Baltimore (M.A.S.); University of Massachusetts Medical Center, Worcester
(J.M.G.); University of Washington, Seattle (W.D.W.); Green Lane Hospital,
Auckland, New Zealand (H.D.W.); Thoraxcenter, Erasmus University, Rotterdam,
The Netherlands (M.L.S.); Sourasky Medical Center, Tel Aviv, Israel (G.I.B.);
and the Cleveland Clinic Foundation, Cleveland, Ohio (E.J.T.).
E-mail mahaf002{at}mc.duke.edu
Background—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.
Methods and Results—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.
Conclusions—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.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Risk Factors for In-hospital Nonhemorrhagic Stroke in Patients With Acute Myocardial Infarction Treated With Thrombolysis
Results From GUSTO-I
Key Words: thrombolysis • myocardial infarction • stroke • cerebral infarction
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