Ischemic cerebral infarction after rt-PA and heparin therapy for acute myocardial infarction: The TIMI-II pilot and randomized clinical trial combined experience

Academic Article


  • Background and Purpose: Ischemic cerebral infarction (CI) is a serious complication of acute myocardial infarction (MI). Little information exists on CI after thrombolytic therapy for MI. Methods: Of 3924 MI patients 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 patients (86%) were men, and 22 (76%) were white. The electrocardiographic 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 others distributed over the 4 weeks after study entry. Six of 29 CIs did not 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 specifically with embolism than MI. Eight of 27 CIs (30%) with CT scans had hemorrhagic transformation of varying degrees; 5 were symptomatic. Conclusions: The time of occurrence and sites of CI after rt-PA and heparin therapy for acute MI are similar to those reported during the prethrombolytic era.
  • Authors

    Published In

  • Stroke  Journal
  • Digital Object Identifier (doi)

    Author List

  • Sloan MA; Price TR; Terrin ML; Forman S; Gore JM; Chaitman BR; Hodges M; Mueller H; Rogers WJ; Knatterud GL
  • Start Page

  • 1107
  • End Page

  • 1114
  • Volume

  • 28
  • Issue

  • 6