| Stroke and acute myocardial infarction in the thrombolytic era: clinical correlates and long-term prognosis. | |
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MedLine Citation:
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PMID: 2117618 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Thirteen (1.8%) of 708 patients with acute myocardial infarction treated with recombinant tissue-type plasminogen activator in the Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) I, II and III trials developed a stroke. Four strokes were hemorrhagic and nine were nonhemorrhagic. Of five prespecified risk factors for intracranial hemorrhage (age greater than 65 years, history of hypertension, history of prior cerebrovascular disease, aspirin use and acute hypertension), two patients had two risk factors and one patient had one risk factor. However, 80% of patients without intracranial hemorrhage had at least one risk factor and 31% had two risk factors. No patient with a prior stroke or transient ischemic attack (all greater than 6 months previously) had an intracranial hemorrhage. Of three prespecified risk factors for nonhemorrhagic stroke (atrial fibrillation, prior cerebrovascular disease and large anterior wall infarction), only the occurrence of a large anterior myocardial infarction (with ejection fraction less than 45%) was a predictor (p = 0.0015). The in-hospital death rate was 25% for patients with hemorrhagic stroke versus 11% for patients with a non-hemorrhagic stroke and 6% for those patients without a stroke. Furthermore, the hospital stay was greater than 50% longer in patients who had a stroke than in those who did not. Thus, intracranial hemorrhage remains an unpredictable risk in patients treated with thrombolytic therapy and cerebral infarction is related to anterior myocardial infarction and poor left ventricular function. Both types of stroke are associated with substantial morbidity and mortality. |
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Authors:
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C M O'Connor; R M Califf; E W Massey; D B Mark; D J Kereiakes; R J Candela; C Abbottsmith; B George; R S Stack; L Aronson |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 16 ISSN: 0735-1097 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 1990 Sep |
Date Detail:
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Created Date: 1990-09-21 Completed Date: 1990-09-21 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 533-40 Citation Subset: AIM; IM |
Affiliation:
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Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Cerebrovascular Disorders / epidemiology*, etiology Clinical Trials as Topic Female Humans Incidence Male Middle Aged Myocardial Infarction / complications, drug therapy* Prognosis Risk Factors Thrombolytic Therapy* Time Factors Tissue Plasminogen Activator / therapeutic use* |
| Grant Support | |
ID/Acronym/Agency:
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HL-36587/HL/NHLBI NIH HHS; HS-05635/HS/AHRQ HHS; LM-07003/LM/NLM NIH HHS |
| Chemical | |
Reg. No./Substance:
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EC 3.4.21.68/Tissue Plasminogen Activator |
| Comments/Corrections | |
Comment In:
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J Am Coll Cardiol. 1990 Sep;16(3):541-4
[PMID:
2201711
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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