ABSTRACT
Background & Objective: Currentlythere is limitedintervention for acute ischemic stroke. Recombinant tissue plasminogen activator (rTPA) has been approved for immediate recanalization after a steno-occlusive lesion of cerebral vessels. rTPA has shown its efficacy and safety from several clinical trials. The present study reports our experience with intravenous rTPA from several centers in the Philippines.Method:This is a retrospective cohort study consisting of 157 patients who qualified to receive rTPA following the NINDS trial inclusion and exclusion criteria. The primary outcome is in-hospital and 3-months mortality. Other outcome measures were determined: intracranial hemorrhage secondary to hemorrhagic conversion and functional outcome as measured by modified Rankin Scale. Additionally, standard dose (0.9mg/kg) was compared to low dose (0.6mg/kg) of rTPA in terms of mortality, intracranial bleeding and functional outcome.Results:The in-hospital mortality was seen in 23 (14.6%) and total death within 3 months was 18.3%. Independent patient (mRS 0-2) was seen in 69 (51.1%) at discharge and 95 (73.1%) at 3 months. Intracranial bleeding due to asymptomatic hemorrhagic transformation occurred in 39 (24.8%) and symptomatic hemorrhagic transformation was seen in 19 (12.1%).Conclusion: Comparing our results with SITS-MOST and Cochrane collaborations, our data showed that we have more independent patients however death and intracranial bleeding was noted to be high in our cohort of patients. Additionally, the study showed more independent patients in the low dose group.
ABSTRACT
BACKGROUND@#Stroke in patients with myocardial infarction result in worse patient outcomes, greater cost and higher risk of mortality. Currently, there has been no published data regarding patients who develop stroke post MI in the Philippines. @*OBJECTIVE@#To describe the occurrence, clinical profile and outcome of patients who had stroke within one year of acute myocardial infarction.@*METHODOLOGY@#Records of patients with acute myocardial infarction (MI) from January 1, 2013 - January 31, 2016 who had a stroke within one year follow up were reviewed to describe the clinical profile of these patients, the mortality rate and functional outcomes at one year post MI.@*RESULTS@#Among patients enrolled in the AMI Program with one year follow up, 11 patients (1.94%) had stroke. Most were males (9/11, 81.82%) with mean age of 60 years. Common findings in these patients were: hypertension (8/11, 72.73%), diabetes mellitus (7/11, 63.64%), smoking (6/11, 54.55%), STEMI (6/11, 54.55%), anterior wall hypo-/akinesia (7/11, 63.64%), concentric left ventricular hypertrophy (7/11, 63.64%) and LAD involvement (7/8 patients, 87.5%). Atrial fibrillation was uncommon (3/11, 27.27%) but was observed in those with earlier (<14 days) strokes, dependence and mortality. Stroke occurrence was highest in the first 2 weeks (7/11, 63.64%) with mean GCS 13+2 and mild in severity (4/11, 36.36%). Cerebrovascular infarction (90.91%) was the most common stroke type, usually due to large artery atherothrombosis (5/10, 50%) and usually with involvement of the MCA (10/10). Hemorrhagic conversion was infrequent (3/10, 30%). Dependence (MRS >3) was seen in 7/11 (54.55%) and mortality (2/11, 18.18%) was slightly higher than non-stroke patients (10/303, 10.23%) at one year-post MI. @*CONCLUSION@#Stroke occurrence was higher in the first two weeks post MI. Most were males, mean ages of 60 years; with hypertension, diabetes and history of smoking; STEMI, anterior wall hypo-/akinesia, concentric LVH, and LAD involvement. Atrial fibrillation was infrequent but was observed in patients with earlier strokes (<14days), more severe disability on discharge and mortality at one year follow up. Dependence (MRS >3) was common at discharge and mortality was higher than those without stroke at one year post MI.