Department of Neurology, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, Shaanxi, China.
Department of Cardiovascular Medicine, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, Shaanxi, China.
J Investig Med. 2022 Dec;70(8):1713-1719. doi: 10.1136/jim-2022-002334.
This study aimed to evaluate the demographic and clinical characteristics, treatments and outcomes of concomitant acute myocardial infarction (AMI) and acute intracranial hemorrhage (ICH). All patients diagnosed with concomitant AMI and acute ICH admitted to our institution were included retrospectively. The patient demographics, clinical characteristics, neuroimaging and treatment approaches were analyzed, and the outcomes of interest included disability as defined by the modified Rankin Scale (mRS) score and all-cause mortality within 1 year of follow-up. Of a total of 4972 patients with AMI, 8 patients (0.2%) with concomitant acute ICH were recruited for the study, including ST-segment elevation myocardial infarction (STEMI, 5 cases) and non-STEMI (3 cases). New-onset acute ICH in 4 of the 5 patients (80%) occurred within 24 hours after the AMI event, and all these patients had a sudden decrease in the level of consciousness, with an average decrease of 4.6 on the Glasgow Coma Scale. All 5 out of 8 patients had irregular shapes and uncommon sites of hematoma presentation documented on CT scans. Unfortunately, 2 patients died from a progression of ICH within 1 week, and 2 of the 6 survivors had poor functional outcomes (mRS ≥3) at the 1-year follow-up. Concomitant acute ICH and AMI are rare complications displaying unique iconography. Acute ICH caused serious prejudice in AMI with higher mortality and poor functional outcomes, and cardiac catheterization without the administration of antithrombotic or antiplatelet agents was feasible for patients who had unstable hemodynamics or STEMI.
本研究旨在评估同时发生的急性心肌梗死（AMI）和急性颅内出血（ICH）的人口统计学和临床特征、治疗方法和结局。回顾性纳入我院收治的所有诊断为同时发生 AMI 和急性 ICH 的患者。分析患者的人口统计学、临床特征、神经影像学和治疗方法，关注的结局包括改良 Rankin 量表（mRS）评分定义的残疾和随访 1 年内的全因死亡率。在总计 4972 例 AMI 患者中，纳入了 8 例（0.2%）同时发生急性 ICH 的患者，包括 ST 段抬高型心肌梗死（STEMI，5 例）和非 ST 段抬高型心肌梗死（3 例）。5 例患者中的 4 例（80%）新发急性 ICH 发生在 AMI 事件后 24 小时内，所有这些患者均出现意识水平突然下降，格拉斯哥昏迷量表评分平均下降 4.6 分。8 例患者中共有 5 例 CT 扫描显示血肿形态不规则和常见部位。不幸的是，2 例患者在 1 周内因 ICH 进展而死亡，6 例幸存者中有 2 例在 1 年随访时功能结局较差（mRS≥3）。同时发生的急性 ICH 和 AMI 是罕见的并发症，表现出独特的影像学特征。急性 ICH 导致 AMI 死亡率更高和功能结局更差，对于血流动力学不稳定或 STEMI 的患者，可行心脏导管术而不给予抗栓或抗血小板药物。
