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Updated: Aug 16, 2026
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Post-thrombolysis intracerebral hemorrhage: data from the Spanish Register ARIAM
Manuel Ruiz-Bailén1, Juan Francisco Brea-Salvago, Eduardo Aguayo de Hoyos
1From the Intensive Care Unit, Critical Care and Emergency Department, Hospital Universitario Médico-Quirúrgico del Complejo Hospitalario de Jaén, Jaén, Spain.
Insights
Acute myocardial infarction (AMI) patients developing intracranial hemorrhage (ICH) were more likely to be older and have hypertension. However, smoking and certain medications like beta-blockers and ACE inhibitors reduced ICH risk and mortality.
Area of Science:
- Cardiology
- Neurology
- Clinical Research
Background:
- Acute myocardial infarction (AMI) is a leading cause of death.
- Intracranial hemorrhage (ICH) is a serious complication of AMI treatment.
- Understanding risk factors for ICH in AMI patients is crucial for improving outcomes.
Purpose of the Study:
- To identify predisposing factors for ICH in AMI patients treated with thrombolysis.
- To determine factors associated with mortality in AMI patients with ICH.
Main Methods:
- Retrospective study of 17,111 patients from the Spanish ARIAM register (1996-2003).
- Univariate and multivariate analyses were used to assess associations with ICH development and mortality.
- Follow-up was limited to the intensive care unit/coronary care unit stay.
Main Results:
- ICH occurred in 0.9% of patients.
- Factors associated with ICH development included older age and arterial hypertension.
- Smoking, beta-blockers, and ACE inhibitors were associated with reduced ICH incidence.
- Mortality rate in ICH patients was 48.3%.
- Factors associated with mortality included older age, arterial hypertension, mechanical ventilation, and cardiopulmonary resuscitation.
- Beta-blockers and ACE inhibitors were associated with reduced mortality.
Conclusions:
- Age and arterial hypertension are key risk factors for ICH in AMI patients.
- Smoking and specific medications (beta-blockers, ACE inhibitors) may offer protection against ICH and reduce mortality.
- These findings highlight the importance of managing hypertension and considering medication choices in AMI patients.
Objective:
Our objective was to investigate the predisposing factors in patients with acute myocardial infarction (AMI) treated with thrombolysis and complicated by intracranial hemorrhage (ICH), as well as the factors associated with death for patients whose conditions were complicated by ICH.
Design:
A retrospective study.
Setting:
An intensive care/critical care unit.
Patients:
All patients with AMI listed in the Spanish ARIAM register.
Interventions:
None.
Measurements And Main Results:
The study period was from June 1996 to December 2003. The follow-up period was limited to the time spent in the intensive care unit/coronary care unit. Associations with the development of ICH were studied by univariate analysis. Another univariate analysis was used to evaluate the differences between patients affected by AMI complicated by ICH who died and those who survived. Two multivariate analyses were also used: one to evaluate the factors related to the development of ICH and the other to evaluate the factors associated with the death of patients with ICH. A total of 17,111 patients with AMI were included in the study. ICH occurred in 151 (0.9%) of these patients during their stay in the intensive care unit/coronary care unit. The multivariate analysis showed that the variables associated with ICH development were smoking (odds ratio [OR], 0.684; 95% confidence interval [CI], 0.478-0.979); oral b-blockers (OR, 0.488; CI, 0.337-0.706); angiotensin-converting enzyme (ACE) inhibitors (OR, 0.480; CI, 0.340-0.678); arterial hypertension (OR, 4.900; CI, 2.758-8.705); age of 55-64 yrs (OR, 2.253; CI, 1.117-4.546); age of 65-74 yrs (OR, 4.240; CI, 2.276-7.901); age of 75-84 yrs (OR, 4.450; CI, 2.319-8.539); and age of >84 yrs (OR, 2.997; CI, 1.039-8.647). The mortality rate among patients with ICH was 48.3%, vs. 8.3% among patients without ICH. The multivariate study showed that the mortality rate among patients with ICH was associated with age (OR, 1.086; CI, 1.033-1.143), arterial hypertension cardiovascular risk factor (OR, 2.773; CI, 1.216-6.324), and the need for mechanical ventilation (OR, 4.324; CI, 1.665-11.230) or cardiopulmonary resuscitation (OR, 12.258; CI, 1.268-118.523). However, the administration of b-blockers (OR, 0.369; CI, 0.136-0.997) or ACE inhibitors (OR, 0.367; CI, 0.149-0.902) was associated with a reduction in the mortality rate.
Conclusions:
Factors associated with the development of ICH in our population were age and arterial hypertension, whereas smoking and the administration of b-blockers or ACE inhibitors were associated with a reduction in incidence. Among patients with AMI complicated by ICH, mortality was associated with age, arterial hypertension, cardiopulmonary resuscitation, and the use of mechanical ventilation, whereas the administration of oral b-blockers and ACE inhibitors could be associated with a reduction in mortality.
