Thrombolysis and stroke risk inacuteMI THERAPY The risk of stroke is increased in patients with acute myocardial infarction (MI) who have elevated BP and who receive thrombolysis, report the GUSTO-l * investigators. In the GUSTO-l trial, 41 021 patients with acute MI who presented within 6 hours of symptom onset were randomised to receive accelerated alteplase + IV heparin, alteplase + streptokinase + IV heparin, streptokinase and IV heparin, or streptokinase + SC heparin. Among the patients involved in the GUSTO-l study, 38.1 % had a history of hypertension. These patients had significantly higher rates of death, stroke and intracranial haemorrhage compared with those who did not have a history of hypertension. Increased risk of stroke In GUSTO-I, the median systolic BP at study entry was 130mm Hg. The mortality rate was shown to decrease as the systolic BP increased, while the rates of stroke and intracranial haemorrhage increased as the systolic BP increased. As the systolic BP increased from the lowest values to a value of 120mm Hg, the combined rate of death and disabling stroke was shown to significantly decrease. However, with very high systolic pressures, a trend emerged indicating an increasing risk of death and disabling stroke. Alteplase vs streptokinase Accelerated alteplase recipients had a higher overall rate of intracranial haemorrhage compared with streptokinase recipients. However, accelerated aJteplase recipients also had a significantly lower combined rate of death and disabling stroke compared with streptokinase recipients. The researchers suggest that among patients with hypertension who are at low risk of cardiac death, 'the risk/or stroke may outweigh the survival benefit produced by thrombolytic therapy'. * Global UtilkPtion of Streptokinase and t-R\for Occluded Coronary Arteries-I [see /nphanna 886: 3,8 May 1993; 800197201J Aylward PE. Wilcox RG. Horgan m. White HD. GUSTO-I Investigaton. Relation of in=ased arterial blood pressure 10 mortality and stroke in the context of contemporary thrombolytic therapy for acute myocardial infarction: a randomized trial. Annals of Intemal Medicine 125: 891-900. 1 Dec 1996 I004I641. 1173-832419711069-000211$01 .00° Adlalnternatlonal LlmItecl1997. All rlghta rnerved 21 Inphanna-11 Jan 1997 No. 1069

Thrombolysis and stroke risk in acute MI

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Thrombolysis and stroke risk inacuteMI

THERAPY

The risk of stroke is increased in patients with acute myocardial infarction (MI) who have elevated BP and who receive thrombolysis, report the GUSTO-l * investigators.

In the GUSTO-l trial, 41 021 patients with acute MI who presented within 6 hours of symptom onset were randomised to receive accelerated alteplase + IV heparin, alteplase + streptokinase + IV heparin, streptokinase and IV heparin, or streptokinase + SC heparin.

Among the patients involved in the GUSTO-l study, 38.1 % had a history of hypertension. These patients had significantly higher rates of death, stroke and intracranial haemorrhage compared with those who did not have a history of hypertension.

Increased risk of stroke In GUSTO-I, the median systolic BP at study entry

was 130mm Hg. The mortality rate was shown to decrease as the systolic BP increased, while the rates of stroke and intracranial haemorrhage increased as the systolic BP increased. As the systolic BP increased from the lowest values to a value of 120mm Hg, the combined rate of death and disabling stroke was shown to significantly decrease. However, with very high systolic pressures, a trend emerged indicating an increasing risk of death and disabling stroke.

Alteplase vs streptokinase Accelerated alteplase recipients had a higher

overall rate of intracranial haemorrhage compared with streptokinase recipients. However, accelerated aJteplase recipients also had a significantly lower combined rate of death and disabling stroke compared with streptokinase recipients.

The researchers suggest that among patients with hypertension who are at low risk of cardiac death, 'the risk/or stroke may outweigh the survival benefit produced by thrombolytic therapy'. * Global UtilkPtion of Streptokinase and t-R\for Occluded Coronary Arteries-I [see /nphanna 886: 3,8 May 1993; 800197201J Aylward PE. Wilcox RG. Horgan m. White HD. GUSTO-I Investigaton. Relation of in=ased arterial blood pressure 10 mortality and stroke in the context of contemporary thrombolytic therapy for acute myocardial infarction: a randomized trial. Annals of Intemal Medicine 125: 891-900. 1 Dec 1996 I004I641.

1173-832419711069-000211$01 .00° Adlalnternatlonal LlmItecl1997. All rlghta rnerved

Inphanna-11 Jan 1997 No. 1069