755-6 Neurosurgical Evacuation for Intracranial Hemorrhage Associated with Improved Outcome in GUSTO

Abstract

In order to evaluate the impact of neurosurgical evacuation of intracranial hemorrhage (ICH) following thrombolytic therapy for acute myocardial infarction, we analyzed the 268 patients with ICH in the GUSTO Trial. In-hospital mortality was 60% with only 13% of patients discharged with minor or no disability. Of the 268 patients, 47 had neurosurgical intervention with the following results: For all patients with ICH, surgical evacuation was associated with a higher likelihood of survival without disability (odds ratio 2.1, 95% CI 0.95–4.7). The prognosis for patients with both SDH and parenchymal hemorrhage was very poor regardless of treatment strategy. Although the differences in outcome may be due in part to selection of patients for operation with lower mortality risk, physicians caring for patients with suspected intracranial hemorrhage following thrombolytic therapy should consider early neurosurgical consultation and intervention to potentially decrease patient disability and improve survival.