Prognostic significance of cerebrovascular disease in 11,526 chronic coronary artery disease patients

To improve this ominous outcome, we believe that a more aggressive approach in the treatment of these patients is needed: thorough implementation of control of existing risk factors together with a more active therapeutic approach in the acute phase of the disease. Although there has been much reservation about the use of thrombolysis in patients with prior CVE, due to fear of intracranial hemorrhage, some recent data have suggested that patients with a nonrecent prior ischemic stroke should not be automatically excluded from thrombolysis. In Israeli national surveys of 2,012 patients with acute myocardial infarction conducted in 1992 and 1994, none of the 29 patients with a prior CVE treated with thrombolysis experienced an intracranial hemorrhage. The 1-year mortality rate was almost half among thrombolyzed versus nonthrombolyzed patients. Therefore, revascularization by thrombolysis should be individually considered in the acute phase of CAD in patients with a past CVE. Alternative reperfusion therapy, such as primary angioplasty or coronary artery bypass grafting, should also be more actively considered in these patients.