Post-thrombolysis intracerebral hemorrhage: data from the Spanish Register ARIAM.
OBJECTIVE
Our objective was to investigate the predisposing factors in patients with acute myocardial infarction (AMI) treated with thrombolysis and complicated by intracranial hemorrhage (ICH), as well as the factors associated with death for patients whose conditions were complicated by ICH.


METHODS
A retrospective study.


METHODS
An intensive care/critical care unit.


METHODS
All patients with AMI listed in the Spanish ARIAM register.


METHODS
None.


RESULTS
The study period was from June 1996 to December 2003. The follow-up period was limited to the time spent in the intensive care unit/coronary care unit. Associations with the development of ICH were studied by univariate analysis. Another univariate analysis was used to evaluate the differences between patients affected by AMI complicated by ICH who died and those who survived. Two multivariate analyses were also used: one to evaluate the factors related to the development of ICH and the other to evaluate the factors associated with the death of patients with ICH. A total of 17,111 patients with AMI were included in the study. ICH occurred in 151 (0.9%) of these patients during their stay in the intensive care unit/coronary care unit. The multivariate analysis showed that the variables associated with ICH development were smoking (odds ratio [OR], 0.684; 95% confidence interval [CI], 0.478-0.979); oral b-blockers (OR, 0.488; CI, 0.337-0.706); angiotensin-converting enzyme (ACE) inhibitors (OR, 0.480; CI, 0.340-0.678); arterial hypertension (OR, 4.900; CI, 2.758-8.705); age of 55-64 yrs (OR, 2.253; CI, 1.117-4.546); age of 65-74 yrs (OR, 4.240; CI, 2.276-7.901); age of 75-84 yrs (OR, 4.450; CI, 2.319-8.539); and age of >84 yrs (OR, 2.997; CI, 1.039-8.647). The mortality rate among patients with ICH was 48.3%, vs. 8.3% among patients without ICH. The multivariate study showed that the mortality rate among patients with ICH was associated with age (OR, 1.086; CI, 1.033-1.143), arterial hypertension cardiovascular risk factor (OR, 2.773; CI, 1.216-6.324), and the need for mechanical ventilation (OR, 4.324; CI, 1.665-11.230) or cardiopulmonary resuscitation (OR, 12.258; CI, 1.268-118.523). However, the administration of b-blockers (OR, 0.369; CI, 0.136-0.997) or ACE inhibitors (OR, 0.367; CI, 0.149-0.902) was associated with a reduction in the mortality rate.


CONCLUSIONS
Factors associated with the development of ICH in our population were age and arterial hypertension, whereas smoking and the administration of b-blockers or ACE inhibitors were associated with a reduction in incidence. Among patients with AMI complicated by ICH, mortality was associated with age, arterial hypertension, cardiopulmonary resuscitation, and the use of mechanical ventilation, whereas the administration of oral b-blockers and ACE inhibitors could be associated with a reduction in mortality.
Ruiz-Bailén
Manuel
M
From the Intensive Care Unit, Critical Care and Emergency Department, Hospital Universitario Médico-Quirúrgico del Complejo Hospitalario de Jaén, Jaén, Spain.
Brea-Salvago
Juan Francisco
JF
de Hoyos
Eduardo Aguayo
EA
Rucabado-Aguilar
Luis
L
Escudero
Guillermo García
GG
Martínez-Escobar
Sergio
S
Rossel-Ortiz
Fernando
F
Mellado-Vergel
José Francisco
JF
Ruiz-Ferrón
Francisco
F
Morante-Valle
Antonia
A
Gómez-Jiménez
Francisco Javier
FJ
Colmenero-Ruiz
Manuel
M
D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000188:drug therapy*; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D015912:Thrombolytic Therapy / Q000009:adverse effects*