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Presenting pulse pressure predicts thrombolytic therapy-related intracranial hemorrhage. Thrombolytic Predictive Instrument (TPI) Project results.

Publication ,  Journal Article
Selker, HP; Beshansky, JR; Schmid, CH; Griffith, JL; Longstreth, WT; O'Connor, CM; Caplan, LR; Massey, EW; D'Agostino, RB; Laks, MM
Published in: Circulation
October 1994

BACKGROUND: In selecting patients with acute myocardial infarction for thrombolytic therapy, it is important to identify patients who are at high risk for intracranial hemorrhage, for whom thrombolytic therapy is ill advised. We hypothesized that presenting pulse blood pressure, representing the "hammer" effect on cerebral vessels and the effects of age on arterial compliance, might predict thrombolysis-related intracranial hemorrhage better than systolic, diastolic, or mean arterial blood pressures. METHODS AND RESULTS: Of 3483 Thrombolytic Predictive Instrument (TPI) Project subjects receiving thrombolytic therapy for acute infarction, we identified and obtained detailed clinical data on the 19 with treatment-related intracranial hemorrhages confirmed by computed tomography and on 175 matched controls. Systolic, diastolic, mean arterial, and pulse blood pressures were each significantly related to the occurrence of intracranial hemorrhage, with pulse pressure most highly related. The mean pulse pressure in patients who developed intracranial hemorrhage was 63 mm Hg, 34% higher than the 47 mm Hg mean value for those not developing hemorrhage (P = .0001). Excess pulse pressure, defined as the extent to which a patient's pulse pressure exceeded 40 mm Hg for systolic blood pressures of at least 120 mm Hg, was even more strongly related: its mean value of 23 mm Hg for patients was 130% higher than its mean value of 10 mm Hg for controls (P < .0001). With logistic regression models to estimate the relative risks (odds ratios) for intracranial hemorrhage conferred by each form of blood pressure, the relative risk for hemorrhage was greatest for excess pulse pressure: for each 10-point pulse pressure excess, the relative risk for intracranial hemorrhage was increased by 1.85 (P = .0002; 95% confidence interval [CI], 1.34 to 2.55) by itself and 1.76 (P = .001; 95% CI, 1.26 to 2.46) when adjusted for age. In this sample, excess pulse pressure by itself predicted hemorrhage as well as systolic pressure and age together. When excess pulse pressure was combined with age to make a logistic regression model predicting intracranial hemorrhage, age contributed less to the prediction than when combined with the other blood pressure forms, even though this model predicted better than any other combination of age and pressure (receiver-operating characteristic curve area, 0.82 versus 0.77 with systolic pressure and age, 0.75 with mean arterial pressure, 0.71 with diastolic pressure, and 0.81 with both systolic and diastolic pressures). CONCLUSIONS: We found that excess pulse blood pressure predicted thrombolysis-related intracranial hemorrhage better than other forms of pretreatment blood pressure, perhaps better describing the pathophysiology of intracranial hemorrhage, including the effect of age. These findings will need confirmation in larger studies with comparable clinical detail.

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Published In

Circulation

DOI

ISSN

0009-7322

Publication Date

October 1994

Volume

90

Issue

4

Start / End Page

1657 / 1661

Location

United States

Related Subject Headings

  • Thrombolytic Therapy
  • Regression Analysis
  • Pulse
  • Odds Ratio
  • Models, Cardiovascular
  • Middle Aged
  • Male
  • Humans
  • Forecasting
  • Female
 

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Selker, H. P., Beshansky, J. R., Schmid, C. H., Griffith, J. L., Longstreth, W. T., O’Connor, C. M., … Laks, M. M. (1994). Presenting pulse pressure predicts thrombolytic therapy-related intracranial hemorrhage. Thrombolytic Predictive Instrument (TPI) Project results. Circulation, 90(4), 1657–1661. https://doi.org/10.1161/01.cir.90.4.1657
Selker, H. P., J. R. Beshansky, C. H. Schmid, J. L. Griffith, W. T. Longstreth, C. M. O’Connor, L. R. Caplan, E. W. Massey, R. B. D’Agostino, and M. M. Laks. “Presenting pulse pressure predicts thrombolytic therapy-related intracranial hemorrhage. Thrombolytic Predictive Instrument (TPI) Project results.Circulation 90, no. 4 (October 1994): 1657–61. https://doi.org/10.1161/01.cir.90.4.1657.
Selker HP, Beshansky JR, Schmid CH, Griffith JL, Longstreth WT, O’Connor CM, et al. Presenting pulse pressure predicts thrombolytic therapy-related intracranial hemorrhage. Thrombolytic Predictive Instrument (TPI) Project results. Circulation. 1994 Oct;90(4):1657–61.
Selker, H. P., et al. “Presenting pulse pressure predicts thrombolytic therapy-related intracranial hemorrhage. Thrombolytic Predictive Instrument (TPI) Project results.Circulation, vol. 90, no. 4, Oct. 1994, pp. 1657–61. Pubmed, doi:10.1161/01.cir.90.4.1657.
Selker HP, Beshansky JR, Schmid CH, Griffith JL, Longstreth WT, O’Connor CM, Caplan LR, Massey EW, D’Agostino RB, Laks MM. Presenting pulse pressure predicts thrombolytic therapy-related intracranial hemorrhage. Thrombolytic Predictive Instrument (TPI) Project results. Circulation. 1994 Oct;90(4):1657–1661.

Published In

Circulation

DOI

ISSN

0009-7322

Publication Date

October 1994

Volume

90

Issue

4

Start / End Page

1657 / 1661

Location

United States

Related Subject Headings

  • Thrombolytic Therapy
  • Regression Analysis
  • Pulse
  • Odds Ratio
  • Models, Cardiovascular
  • Middle Aged
  • Male
  • Humans
  • Forecasting
  • Female