ISCHEMIC CEREBRAL INFARCTION AFTER RT-PA AND HEPARIN-THERAPY FOR ACUTE MYOCARDIAL-INFARCTION - THE TIMI-II PILOT AND RANDOMIZED CLINICAL-TRIAL COMBINED EXPERIENCE

Background and Purpose Ischemic cerebral infarction (CI) is a serious complication of acute myocardial infarction (MI). Little information e xists on CI after thrombolytic therapy for MI. Methods Of 3924 MI pati ents treated with recombinant tissue plasminogen activator (rt-PA) and heparin, 29 (0.7%) developed CI after treatment. All CI patients had detailed neurological evaluations, and 27 (93%) had CT scans centrally reviewed. Results Age range was 40 to 74 years (mean, 60 years); 25 p atients (86%) were men, and 22 (76%) were white. The electrocardiograp hic location of MI was anterior in 22 (76%) and nonanterior in 7 (24%) . Five CIs occurred within 6 hours, 4 between 6 to 24 hours, 8 during the remainder of the first week, 10 during the second week, and 2 othe rs distributed over the 4 weeks after study entry. Six of 29 CIs did n ot involve the cerebral cortex; 9 patients (31%) had multiple CIs. Of 28 CIs thought to be embolic in origin, 17 showed strong evidence for at least one cardiac abnormality (mural clot, wall-motion abnormality, aneurysm, or atrial fibrillation) known to be associated more specifi cally with embolism than MI. Eight of 27 CIs (30%) with CT scans had h emorrhagic transformation of varying degrees; 5 were symptomatic. Conc lusions The time of occurrence and sites of CI after rt-PA and heparin therapy for acute MT are similar to those reported during the prethro mbolytic era.