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(Circulation. 1998;98:1376-1382.)
© 1998 American Heart Association, Inc.

Clinical Investigation and Reports

Prediction of 30-Day Mortality Among Patients With Thrombolysis-Related Intracranial Hemorrhage

Michael A. Sloan, MD; Cathy A. Sila, MD; Kenneth W. Mahaffey, MD; Christopher B. Granger, MD; W. T. Longstreth, Jr, MD, MPH; Peter Koudstaal, MD; Harvey D. White, MB, DSc; Joel M. Gore, MD; Maarten L. Simoons, MD; W. Douglas Weaver, MD; Cindy L. Green, MS; Eric J. Topol, MD; Robert M. Califf, MD; ; for the GUSTO-I Investigators

From the University of Maryland Medical System, Baltimore (M.A.S.); the Cleveland Clinic Foundation, Cleveland, Ohio (C.A.S., E.J.T.); Duke Clinical Research Institute, Durham, North Carolina (K.W.M., C.B.G., C.L.G., R.M.C.); University of Washington, Seattle (W.T.L., W.D.W.); Erasmus Universiteit, Rotterdam, the Netherlands (P.K., M.L.S.); Green Lane Hospital, Auckland, New Zealand (H.D.W.); and the University of Massachusetts Medical Center, Worcester (J.M.G.).

Correspondence to Michael A. Sloan, MD, Department of Neurosciences, Harbin Clinic, 1825 Martha Berry Blvd, Rome, GA 30165-1698.

Background—Limited information exists on risk factors for mortality after thrombolysis-related intracranial hemorrhage. We wished to determine the characteristics associated with 30-day mortality after thrombolysis-related intracranial hemorrhage.

Methods and Results—We performed an observational analysis within a randomized trial of 4 thrombolytic therapies, conducted in 1081 hospitals in 15 countries. Patients presented with ST-segment elevation within 6 hours of symptom onset. Our population was composed of the 268 patients who had primary intracranial hemorrhage after thrombolysis. With univariable and multivariable analyses, we identified clinical and brain imaging characteristics that would predict 30-day mortality among these patients. CT or MRI were available for 240 patients (90%). The 30-day mortality rate was 59.7%. Glasgow Coma Scale score, age, time from thrombolysis to symptoms of intracranial hemorrhage, hydrocephalus, herniation, mass effect, intraventricular extension, and volume and location of intracranial hemorrhage were significant univariable predictors. Multivariable analysis of 170 patients with complete data, 98 of whom died, identified the following independent, significant predictors: Glasgow Coma Scale score (², 19.3; P<0.001), time from thrombolysis to intracranial hemorrhage (², 15.8; P<0.001), volume of intracranial hemorrhage (², 11.6; P<0.001), and baseline clinical predictors of mortality in the overall GUSTO-I trial (², 10.3; P=0.001). The final model had a C-index of 0.931.

Conclusions—This model provides excellent discrimination between patients who are likely to live and those who are likely to die after thrombolytic-related intracranial hemorrhage; this may aid in making decisions about the appropriate level of care for such patients.

Key Words: thrombolysis • hemorrhage • mortality • prognosis • myocardial infarction

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