Ischemic cerebral infarction after rt-PA and heparin therapy for acute myocardial infarction. The TIMI-II pilot and randomized clinical trial combined experience.
OBJECTIVE
Ischemic cerebral infarction (CI) is a serious complication of acute myocardial infarction (MI). Little information exists on CI after thrombolytic therapy for MI.


METHODS
Of 3924 MI patients treated with recombinant tissue plasminogen activator (rt-PA) and heparin, 29 (0.7%) developed CI after treatment. All CI patients had detailed neurological evaluations, and 27 (93%) had CT scans centrally reviewed.


RESULTS
Age range was 40 to 74 years (mean, 60 years); 25 patients (86%) were men, and 22 (76%) were white. The electrocardiographic location of MI was anterior in 22 (76%) and nonanterior in 7 (24%). Five CIs occurred within 6 hours, 4 between 6 to 24 hours, 8 during the remainder of the first week, 10 during the second week, and 2 others distributed over the 4 weeks after study entry. Six of 29 CIs did not involve the cerebral cortex; 9 patients (31%) had multiple CIs. Of 28 CIs thought to be embolic in origin, 17 showed strong evidence for at least one cardiac abnormality (mural clot, wall-motion abnormality, aneurysm, or atrial fibrillation) known to be associated more specifically with embolism than MI. Eight of 27 CIs (30%) with CT scans had hemorrhagic transformation of varying degrees; 5 were symptomatic.


CONCLUSIONS
The time of occurrence and sites of CI after rt-PA and heparin therapy for acute MI are similar to those reported during the prethrombolytic era.
Sloan
M A
MA
Maryland Medical Research Institute, Baltimore 21210, USA.
Price
T R
TR
Terrin
M L
ML
Forman
S
S
Gore
J M
JM
Chaitman
B R
BR
Hodges
M
M
Mueller
H
H
Rogers
W J
WJ
Knatterud
G L
GL
Braunwald
E
E
D000328:Adult; D000368:Aged; D002543:Cerebral Hemorrhage / Q000139:chemically induced; D002544:Cerebral Infarction / Q000139:chemically induced* / Q000000981:diagnostic imaging; D005260:Female; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D010865:Pilot Projects; D011994:Recombinant Proteins / Q000009:adverse effects; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed
D011994:Recombinant Proteins; D006493:Heparin; D010959:Tissue Plasminogen Activator