Neurosurgical evacuation of intracranial hemorrhage after thrombolytic therapy for acute myocardial infarction: Experience from the GUSTO-I Trial

Background Intracranial hemorrhage is an uncommon but very dangerous compli cation in patients receiving thrombolytic therapy for acute myocardial infa rction. Neurosurgical evacuation is often an available treatment option. Ho wever, the association between neurosurgical evacuation and clinical outcom es in these patients has yet to be determined. Methods The GUSTO-I trial randomly assigned 41,021 patients with acute myoc ardial infarction to 1 of 4 thrombolytic strategies in 1081 hospitals in 15 countries. A total of 268 patients (0.65%) had an intracranial hemorrhage. We assessed differences in clinical characteristics, neuroimaging features , Glasgow coma scale scores, functional status (disabled: moderate or sever e deficit; not disabled: no or minor deficit) and 30-day mortality rate bet ween the 46 patients who underwent neurosurgical evacuation and the 222 pat ients who did not. Results Mortality rate ai 30 days for all patients with intracranial hemorr hage was 60%; an additional 27% were disabled. Evacuation was associated wi th significantly higher 30-day survival (65% versus 35%, P < .001) and a tr end toward improved functional status (nondisabling stroke. 20% versus 12%, P = .15). Conclusions Although intracranial hemorrhage is uncommon oiler thrombolysis for acute myocardial infarction, 87% of patients die or have disabling str oke. Although not definitive, these data indicate that neurosurgical evacua tion may be associated with improved clinical outcomes. Physicians treating such patients should consider early neurosurgical consultation and interve ntion in these patients.