Background: Previous reports have associated acute coronary syndromes(ACSs) with cerebrovascular disease but in general have not included long- term patient follow- up or have not analyzed ischemic and hemorrhagic cer...Background: Previous reports have associated acute coronary syndromes(ACSs) with cerebrovascular disease but in general have not included long- term patient follow- up or have not analyzed ischemic and hemorrhagic cerebrovascular events separately. Methods: We analyzed stroke outcomes from the OPUS- TIMI 16 study, a multicenter, randomized, placebo- controlled trial. Patients were randomized to aspirin plus either orbofiban or placebo and followed for up to 1 year. Cerebrovascular events were prospectively identified and classified by a committee of cardiologists and neurologists blinded to treatment assignment. Results: During 10 months of follow- up, there were 150(1.5% ) patients with cerebrovascular events. Risk factors for ischemic stroke(n=67) and transient ischemic attack(TIA)(n=44) were age, prior ischemic stroke, history of hypertension, and increased heart rate. Prior ischemic stroke and history of hypertension were not risk factors for 30- day ischemic stroke or TIA. Risk factors for intracranial hemorrhage(ICH)(n=14) were age, history of hypertension, history of TIA, and coronary angiography with evidence of coronary artery disease. Compared with placebo, treatment with orbofiban was associated with a nonsignificant increased risk of ischemic stroke or TIA(HR 1.15, 95% CI 0.76- 1.74, P=.51)and ICH(HR 1.25, 95% CI 0.39- 4.00, P=.70). Conclusions: The overall incidence of cerebrovascular events after ACS was highest in the first 30 days then declined; risk factors for cerebrovascular events may be different in the different periods. Orbofiban, despite no significant excess risk of ICH, was not effective in preventing ischemic stroke or TIA.展开更多
Background and Purpose -Some patients with mild or improving ischemic stroke symptoms do not receive intravenous tissue plasminogen activator (tPA) because they look “too good to treat”(TGT); however, some have poor...Background and Purpose -Some patients with mild or improving ischemic stroke symptoms do not receive intravenous tissue plasminogen activator (tPA) because they look “too good to treat”(TGT); however, some have poor outcomes. Methods -We retrospectively analyzed data from a prospective singlecenter study between 2002 and 2004. TGT patients were those arriving within 3 hours of symptom onset and not treated with intravenous tPA solely because of mild or improving symptoms. Results -Of 128 patients presenting within 3 hours, 41 (34%)were not given tPA because of mild or improving stroke. Of the TGT patients, 11 of 41 (27%) died or were not discharged home because of neurological worsening (n=6) or persistent “mild”neurological deficit (n=5). No single variable at presentation was associated with death or lack of home discharge. There were 10 of 41 TGT patients (24%) who had >4-point improvement in National Institutes of Health Stroke Scale score before tPA decision; these patients were more likely to have subsequent neurological worsening (relative risk, 4.1, 95%CI, 1.1 to 15.4; P=0.05). Conclusion -A substantial minority of patients deemed too good for intravenous tPA were unable to be discharged home. A re-evaluation of the stroke severity criteria for tPA eligibility may be indicated.展开更多
文摘Background: Previous reports have associated acute coronary syndromes(ACSs) with cerebrovascular disease but in general have not included long- term patient follow- up or have not analyzed ischemic and hemorrhagic cerebrovascular events separately. Methods: We analyzed stroke outcomes from the OPUS- TIMI 16 study, a multicenter, randomized, placebo- controlled trial. Patients were randomized to aspirin plus either orbofiban or placebo and followed for up to 1 year. Cerebrovascular events were prospectively identified and classified by a committee of cardiologists and neurologists blinded to treatment assignment. Results: During 10 months of follow- up, there were 150(1.5% ) patients with cerebrovascular events. Risk factors for ischemic stroke(n=67) and transient ischemic attack(TIA)(n=44) were age, prior ischemic stroke, history of hypertension, and increased heart rate. Prior ischemic stroke and history of hypertension were not risk factors for 30- day ischemic stroke or TIA. Risk factors for intracranial hemorrhage(ICH)(n=14) were age, history of hypertension, history of TIA, and coronary angiography with evidence of coronary artery disease. Compared with placebo, treatment with orbofiban was associated with a nonsignificant increased risk of ischemic stroke or TIA(HR 1.15, 95% CI 0.76- 1.74, P=.51)and ICH(HR 1.25, 95% CI 0.39- 4.00, P=.70). Conclusions: The overall incidence of cerebrovascular events after ACS was highest in the first 30 days then declined; risk factors for cerebrovascular events may be different in the different periods. Orbofiban, despite no significant excess risk of ICH, was not effective in preventing ischemic stroke or TIA.
文摘Background and Purpose -Some patients with mild or improving ischemic stroke symptoms do not receive intravenous tissue plasminogen activator (tPA) because they look “too good to treat”(TGT); however, some have poor outcomes. Methods -We retrospectively analyzed data from a prospective singlecenter study between 2002 and 2004. TGT patients were those arriving within 3 hours of symptom onset and not treated with intravenous tPA solely because of mild or improving symptoms. Results -Of 128 patients presenting within 3 hours, 41 (34%)were not given tPA because of mild or improving stroke. Of the TGT patients, 11 of 41 (27%) died or were not discharged home because of neurological worsening (n=6) or persistent “mild”neurological deficit (n=5). No single variable at presentation was associated with death or lack of home discharge. There were 10 of 41 TGT patients (24%) who had >4-point improvement in National Institutes of Health Stroke Scale score before tPA decision; these patients were more likely to have subsequent neurological worsening (relative risk, 4.1, 95%CI, 1.1 to 15.4; P=0.05). Conclusion -A substantial minority of patients deemed too good for intravenous tPA were unable to be discharged home. A re-evaluation of the stroke severity criteria for tPA eligibility may be indicated.
