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Meta-analysis of intracranial hemorrhage in acute coronary syndromes: incidence, predictors, and clinical outcomes.
- Source :
-
Journal of the American Heart Association [J Am Heart Assoc] 2015 Jun 18; Vol. 4 (6), pp. e001512. Date of Electronic Publication: 2015 Jun 18. - Publication Year :
- 2015
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Abstract
- Background: Little is known about the incidence, predictors, or outcomes of intracranial hemorrhage (ICH) in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS). We aimed to determine the incidence and timing of ICH, characterize the location of ICH, and identify independent baseline predictors of ICH in NSTE ACS patients.<br />Methods and Results: We pooled patient-level data from 4 contemporary antithrombotic therapy trials. Multivariable modeling identified independent predictors of ICH. ICHs were adjudicated by a clinical events committee. Of 37 815 patients, 135 (0.4%) had an ICH. The median (25th, 75th percentiles) follow-up was 332 (184, 434) days but differed across trials. Locations of ICH were intracerebral (50%), subdural (31%), subarachnoid (18.5%), and intraventricular (11%). Independent predictors of ICH were older age (HR per 10 years, 1.61; 95% CI, 1.35 to 1.91); prior stroke/transient ischemic attack; HR, 1.95; 95% CI, 1.14 to 3.35), higher systolic blood pressure; HR per 10 mm Hg increase, 1.09; 95% CI, 1.01 to 1.18), and larger number of antithrombotic agents (HR per each additional agent, 2.06; 95% CI, 1.49 to 2.84). Of all ICHs, 45 (33%) were fatal.<br />Conclusions: In patients with NSTE ACS enrolled in recent clinical trials of antithrombotic therapies, ICH was uncommon. Patients with older age, prior transient ischemic attack/stroke, higher systolic blood pressure, or larger number of antithrombotic agents were at increased risk. One-third of patients with ICH died. These data may be useful to trialists and data and safety monitoring committees for trial conduct and monitoring.<br />Clinical Trial Registration: URL: https://www.clinicaltrials.gov/. Unique identifiers: TRACER: NCT00527943, PLATO: NCT00391872, APPRAISE-2: NCT00831441, TRILOGY ACS: NCT00699998.<br /> (© 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.)
- Subjects :
- Age Factors
Aged
Cerebral Hemorrhage epidemiology
Cerebral Hemorrhage etiology
Cerebral Hemorrhage mortality
Female
Fibrinolytic Agents adverse effects
Humans
Hypertension complications
Incidence
Intracranial Hemorrhages epidemiology
Intracranial Hemorrhages mortality
Male
Middle Aged
Risk Factors
Subarachnoid Hemorrhage epidemiology
Subarachnoid Hemorrhage etiology
Subarachnoid Hemorrhage mortality
Acute Coronary Syndrome complications
Intracranial Hemorrhages etiology
Subjects
Details
- Language :
- English
- ISSN :
- 2047-9980
- Volume :
- 4
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Journal of the American Heart Association
- Publication Type :
- Academic Journal
- Accession number :
- 26089177
- Full Text :
- https://doi.org/10.1161/JAHA.114.001512