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Reactions 634 - 18 Jan 1997
Thrombolysis and stroke risk inacute MI
The risk of stroke is increased in patients with acutemyocardial infarction (MI) who have elevated BP andwho receive thrombolysis, report the GUSTO-1*
Investigators.In the GUSTO-1 trial, 41 021 patients with acute MI
who presented within 6 hours of symptom onset wererandomised to receive accelerated alteplase + IVheparin, alteplase + streptokinase + IV heparin,streptokinase and IV heparin, or streptokinase + SCheparin.
Among the patients involved in the GUSTO-1 study,38.1% had a history of hypertension. These patients hadsignificantly higher rates of death, stroke and intracranialhaemorrhage compared with those who did not have ahistory of hypertension.
Increased risk of strokeIn GUSTO-1, the median systolic BP at study entry
was 130mm Hg. The mortality rate was shown todecrease as the systolic BP increased, while the rates ofstroke and intracranial haemorrhage increased as thesystolic BP increased. As the systolic BP increased fromthe lowest values to a value of 120mm Hg, thecombined rate of death and disabling stroke was shownto significantly decrease. However, with very highsystolic pressures, a trend emerged indicating anincreasing risk of death and disabling stroke.
Alteplase vs streptokinaseAccelerated alteplase recipients had a higher overall
rate of intracranial haemorrhage compared withstreptokinase recipients. However, accelerated alteplaserecipients also had a significantly lower combined rateof death and disabling stroke compared withstreptokinase recipients.
The researchers suggest that among patients withhypertension who are at low risk of cardiac death, ‘therisk for stroke may outweigh the survival benefitproduced by thrombolytic therapy’.* Global Utilization of Streptokinase and t-PA for Occluded CoronaryArteries-1
Aylward PE, et al. Relation of increased arterial blood pressure to mortality andstroke in the context of contemporary thrombolytic therapy for acute myocardialinfarction: a randomized trial. Annals of Internal Medicine 125: 891-900, 1 Dec1996 800486419
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Reactions 18 Jan 1997 No. 6340114-9954/10/0634-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved