Intracranial Hemorrhage Following Acute MI Rare, Increases Mortality

Intracranial hemorrhage (ICH) following acute myocardial infarction (AMI) increases risk of mortality, but the incidence is low, according to findings published in the International Journal of Cardiology.

Investigators sought to characterize incidence, presentation, treatment, prevention, and prognosis of ICH in AMI. In-hospital mortality was the primary endpoint.

The investigators conducted a monocentric observational study that included electronic data on 5257 patients with AMI from October 2015 to October 2020, of whom 14 (0.27%; 3 women; age range, 45 to 77 years) subsequently experienced ICH. The study was conducted at the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China. Among these 14 patients, 10 experienced ST-segment elevation myocardial infarction (STEMI) and 4 experienced non-STEMI, 8 had history of hypertension, 5 had history of hyperlipidemia, 4 had history of stroke, and 5 patients smoked.

According to the Academic Research Consortium for High Bleeding Risk (ARC-HBR) score, 7 patients were high risk for bleeding. According to the CRUSADE score, 6 patients were high/very high risk for bleeding. Among all 14 patients with ICH, 4 scored high or very high on both tests. Among those scoring high or very high on ARC-HBR, 5 died. Among those scoring high or very high on CRUSADE, 3 died. Among those who scored high or very high on both tests, 2 died. This led investigators to claim CRUSADE and ARC-HBR scores effectively predict ICH following AMI, and work in tandem to assess patient risk.

Within 48 hours after AMI, 5 patients experienced bleeding. ICH ultimately presented in 8 patients with lobar hemorrhages, and in 4 patients with subarachnoid hemorrhages.

Overall, 8 patients died in-hospital.

Following sudden loss of consciousness, 8 of 9 patients who lost consciousness died in-hospital, all within 4 days of ICH onset. Among the patients who died, 2 were treated with conservative drug therapy, 1 was treated with thrombolysis, and 5 were treated with percutaneous coronary intervention therapy.

Among patients who died in-hospital vs those ultimately discharged, volume of ICH was significantly higher (7 of 8 patients who died in hospital had ICH volumes of >30 mL, suggesting 30 mL may be a threshold).

Study limitations include the single-center and retrospective design, underpowered sample size, limited generalizability, and possible underestimation of subclinical cerebral hemorrhage in all patients.

“The incidence of ICH following myocardial infarction is low; however, the mortality rate is extremely high, presenting considerable challenges for clinical treatment,” the investigators wrote. “The volume of ICH is closely related to patient outcomes, and early detection coupled with timely symptomatic treatment are essential for improving prognosis.”