Maggioni A P, Franzosi M G, Farina M L, Santoro E, Celani M G, Ricci S, Tognoni G
Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy.
BMJ. 1991 Jun 15;302(6790):1428-31. doi: 10.1136/bmj.302.6790.1428.
To describe the epidemiology of cerebrovascular events in patients given or not given fibrinolytic treatment and to assess the prognostic implications and risk factors.
Case series derived from the GISSI randomised trial.
176 coronary care units in Italy giving various levels of care.
5860 patients with acute myocardial infarction treated with 1.5 million units of intravenous streptokinase and 5852 patients not given fibrinolytic treatment.
Cerebrovascular event, sex, age, blood pressure, history of previous infarct, site of infarction, and Killip class.
99 of 11,712 patients (0.84%) had a cerebrovascular event. Older age, worse Killip class, and anterior location of infarction seemed to be risk factors for cerebrovascular events (40/3201 aged 65-75 v 42/7295 aged less than 65, odds ratio 2.18; 9/437 class 3 v 55/8277 class 1, 1.81; and 57/4878 anterior v 24/4013 posterior, 1.96). No significant difference was found in the rate of cerebrovascular events between patients treated with streptokinase and controls (45/5852 (0.92%) streptokinase v 54/5860 (0.77) control). More patients in the streptokinase group than in the control group had cerebrovascular events (especially haemorrhagic strokes) on day 0-1 after randomisation (27 streptokinase v 7, control), although this was balanced by late events in control patients (54 streptokinase v 45 control at one year). The mortality of patients who had a cerebrovascular event was higher than that of those who did not (47% (47/99) v 11.6% (1350/11,613].
Although the incidence of cerebrovascular events complicating myocardial infarction was low, they increased morbidity and mortality. Treatment with streptokinase did not significantly alter the incidence, but age and poor haemodynamic state were associated with an increased risk.
描述接受或未接受纤溶治疗患者的脑血管事件流行病学，并评估其预后影响和危险因素。
源自GISSI随机试验的病例系列。
意大利176个提供不同护理水平的冠心病监护病房。
5860例接受150万单位静脉注射链激酶治疗的急性心肌梗死患者和5852例未接受纤溶治疗的患者。
脑血管事件、性别、年龄、血压、既往梗死病史、梗死部位和Killip分级。
11712例患者中有99例（0.84%）发生脑血管事件。年龄较大、Killip分级较差和梗死部位在前壁似乎是脑血管事件的危险因素（65 - 75岁组40/3201例对比小于65岁组42/7295例，比值比2.18；3级组9/437例对比1级组55/8277例，1.81；前壁梗死组57/4878例对比后壁梗死组24/4013例，1.96）。接受链激酶治疗的患者与对照组之间脑血管事件发生率无显著差异（链激酶组45/5852例（0.92%）对比对照组54/5860例（0.77%））。随机分组后第0 - 1天，链激酶组发生脑血管事件（尤其是出血性卒中）的患者比对照组多（链激酶组27例对比对照组7例），尽管后期对照组患者事件数与之平衡（1年后链激酶组54例对比对照组45例）。发生脑血管事件患者的死亡率高于未发生者（47%（47/99）对比11.6%（1350/11613））。
尽管心肌梗死并发脑血管事件的发生率较低，但它们增加了发病率和死亡率。链激酶治疗并未显著改变发病率，但年龄和血流动力学状态不佳与风险增加相关。
