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Roquer J, Cuadrado-Godia E, Guimaraens L, Conesa G, Rodríguez-Campello A, Capellades J, García-Arnillas MP, Fernández-Candil JL, Avellaneda-Gómez C, Giralt-Steinhauer E, Jiménez-Conde J, Soriano-Tárraga C, Villalba-Martínez G, Vivanco-Hidalgo RM, Vivas E, Ois A. Short- and long-term outcome of patients with aneurysmal subarachnoid hemorrhage. Neurology 2020; 95:e1819-e1829. [PMID: 32796129 PMCID: PMC7682825 DOI: 10.1212/wnl.0000000000010618] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 06/08/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To describe short-term and 5-year rates of mortality and poor outcome in patients with spontaneous aneurysmal subarachnoid hemorrhage (aSAH) who received repair treatment. METHODS In this prospective observational study, mortality and poor outcome (modified Rankin Scale score 3-6) were analyzed in 311 patients with aSAH at 3 months, 1 year, and 5 years follow-up. Sensitivity analysis was performed according to treatment modality. In-hospital and 5-year complications were analyzed. RESULTS Of 476 consecutive patients with spontaneous subarachnoid hemorrhage, 347 patients (72.9%) had aSAH. Of these, 311 (89.6%) were treated (242 endovascular, 69 neurosurgical), with a mean follow-up of 43.4 months (range, 1 to 145). Three-month, 1-year, and 5-year mortality was 18.4%, 22.9%, and 29.0%, and poor outcome was observed in 42.3%, 36.0%, and 36.0%, respectively. Adjusted poor outcome was lower in endovascular than in neurosurgical treatment at 3 months (odds ratio [OR] 0.36 [95% confidence interval [CI] 0.18-0.74]), with an absolute difference of 15.8% (number needed to treat = 6.3), and at 1 year (OR = 0.40 [95% CI 0.20-0.81]), with an absolute difference of 15.9% (number needed to treat = 6.3). Complications did not differ between the 2 procedures. However, mechanical ventilation was less frequent with the endovascular technique (OR 0.67 [95% CI 0.54-0.84]). CONCLUSIONS Patients with aSAH treated according to current guidelines had a short-term mortality of 18.4% and 5-year mortality of 29%. The majority (64.0%) of patients remained alive without disabilities at 5-year follow-up. Patients prioritized to endovascular treatment had better outcomes than those referred to neurosurgery because endovascular coiling was not feasible.
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Affiliation(s)
- Jaume Roquer
- From Servei de Neurologia (J.R., E.C.-G., A.R.-C., C.A.-G., E.G.-S., J.J.-C., C.S.-T., R.M.V.-H., A.O.), Departament J Merland de Neuroangiografia Terapèutica (L.G., E.V.), Servei de Neurocirurgia (G.C., G.V.-M.), Servei de Neuroradiologia (J.C.), Servei de Medicina Intensiva (M.P.G.-A.), and Servei d'Anestèsia i Reanimació (J.L.F.-C.), IMIM-Hospital del Mar, Barcelona; and Departament de Medicina (J.R., E.C.-G., A.R.-C., A.O.), Universitat Autònoma de Barcelona i DCEXS-Universitat Pompeu Fabra, Spain.
| | - Elisa Cuadrado-Godia
- From Servei de Neurologia (J.R., E.C.-G., A.R.-C., C.A.-G., E.G.-S., J.J.-C., C.S.-T., R.M.V.-H., A.O.), Departament J Merland de Neuroangiografia Terapèutica (L.G., E.V.), Servei de Neurocirurgia (G.C., G.V.-M.), Servei de Neuroradiologia (J.C.), Servei de Medicina Intensiva (M.P.G.-A.), and Servei d'Anestèsia i Reanimació (J.L.F.-C.), IMIM-Hospital del Mar, Barcelona; and Departament de Medicina (J.R., E.C.-G., A.R.-C., A.O.), Universitat Autònoma de Barcelona i DCEXS-Universitat Pompeu Fabra, Spain
| | - Leopoldo Guimaraens
- From Servei de Neurologia (J.R., E.C.-G., A.R.-C., C.A.-G., E.G.-S., J.J.-C., C.S.-T., R.M.V.-H., A.O.), Departament J Merland de Neuroangiografia Terapèutica (L.G., E.V.), Servei de Neurocirurgia (G.C., G.V.-M.), Servei de Neuroradiologia (J.C.), Servei de Medicina Intensiva (M.P.G.-A.), and Servei d'Anestèsia i Reanimació (J.L.F.-C.), IMIM-Hospital del Mar, Barcelona; and Departament de Medicina (J.R., E.C.-G., A.R.-C., A.O.), Universitat Autònoma de Barcelona i DCEXS-Universitat Pompeu Fabra, Spain
| | - Gerardo Conesa
- From Servei de Neurologia (J.R., E.C.-G., A.R.-C., C.A.-G., E.G.-S., J.J.-C., C.S.-T., R.M.V.-H., A.O.), Departament J Merland de Neuroangiografia Terapèutica (L.G., E.V.), Servei de Neurocirurgia (G.C., G.V.-M.), Servei de Neuroradiologia (J.C.), Servei de Medicina Intensiva (M.P.G.-A.), and Servei d'Anestèsia i Reanimació (J.L.F.-C.), IMIM-Hospital del Mar, Barcelona; and Departament de Medicina (J.R., E.C.-G., A.R.-C., A.O.), Universitat Autònoma de Barcelona i DCEXS-Universitat Pompeu Fabra, Spain
| | - Ana Rodríguez-Campello
- From Servei de Neurologia (J.R., E.C.-G., A.R.-C., C.A.-G., E.G.-S., J.J.-C., C.S.-T., R.M.V.-H., A.O.), Departament J Merland de Neuroangiografia Terapèutica (L.G., E.V.), Servei de Neurocirurgia (G.C., G.V.-M.), Servei de Neuroradiologia (J.C.), Servei de Medicina Intensiva (M.P.G.-A.), and Servei d'Anestèsia i Reanimació (J.L.F.-C.), IMIM-Hospital del Mar, Barcelona; and Departament de Medicina (J.R., E.C.-G., A.R.-C., A.O.), Universitat Autònoma de Barcelona i DCEXS-Universitat Pompeu Fabra, Spain
| | - Jaume Capellades
- From Servei de Neurologia (J.R., E.C.-G., A.R.-C., C.A.-G., E.G.-S., J.J.-C., C.S.-T., R.M.V.-H., A.O.), Departament J Merland de Neuroangiografia Terapèutica (L.G., E.V.), Servei de Neurocirurgia (G.C., G.V.-M.), Servei de Neuroradiologia (J.C.), Servei de Medicina Intensiva (M.P.G.-A.), and Servei d'Anestèsia i Reanimació (J.L.F.-C.), IMIM-Hospital del Mar, Barcelona; and Departament de Medicina (J.R., E.C.-G., A.R.-C., A.O.), Universitat Autònoma de Barcelona i DCEXS-Universitat Pompeu Fabra, Spain
| | - María P García-Arnillas
- From Servei de Neurologia (J.R., E.C.-G., A.R.-C., C.A.-G., E.G.-S., J.J.-C., C.S.-T., R.M.V.-H., A.O.), Departament J Merland de Neuroangiografia Terapèutica (L.G., E.V.), Servei de Neurocirurgia (G.C., G.V.-M.), Servei de Neuroradiologia (J.C.), Servei de Medicina Intensiva (M.P.G.-A.), and Servei d'Anestèsia i Reanimació (J.L.F.-C.), IMIM-Hospital del Mar, Barcelona; and Departament de Medicina (J.R., E.C.-G., A.R.-C., A.O.), Universitat Autònoma de Barcelona i DCEXS-Universitat Pompeu Fabra, Spain
| | - Juan L Fernández-Candil
- From Servei de Neurologia (J.R., E.C.-G., A.R.-C., C.A.-G., E.G.-S., J.J.-C., C.S.-T., R.M.V.-H., A.O.), Departament J Merland de Neuroangiografia Terapèutica (L.G., E.V.), Servei de Neurocirurgia (G.C., G.V.-M.), Servei de Neuroradiologia (J.C.), Servei de Medicina Intensiva (M.P.G.-A.), and Servei d'Anestèsia i Reanimació (J.L.F.-C.), IMIM-Hospital del Mar, Barcelona; and Departament de Medicina (J.R., E.C.-G., A.R.-C., A.O.), Universitat Autònoma de Barcelona i DCEXS-Universitat Pompeu Fabra, Spain
| | - Carla Avellaneda-Gómez
- From Servei de Neurologia (J.R., E.C.-G., A.R.-C., C.A.-G., E.G.-S., J.J.-C., C.S.-T., R.M.V.-H., A.O.), Departament J Merland de Neuroangiografia Terapèutica (L.G., E.V.), Servei de Neurocirurgia (G.C., G.V.-M.), Servei de Neuroradiologia (J.C.), Servei de Medicina Intensiva (M.P.G.-A.), and Servei d'Anestèsia i Reanimació (J.L.F.-C.), IMIM-Hospital del Mar, Barcelona; and Departament de Medicina (J.R., E.C.-G., A.R.-C., A.O.), Universitat Autònoma de Barcelona i DCEXS-Universitat Pompeu Fabra, Spain
| | - Eva Giralt-Steinhauer
- From Servei de Neurologia (J.R., E.C.-G., A.R.-C., C.A.-G., E.G.-S., J.J.-C., C.S.-T., R.M.V.-H., A.O.), Departament J Merland de Neuroangiografia Terapèutica (L.G., E.V.), Servei de Neurocirurgia (G.C., G.V.-M.), Servei de Neuroradiologia (J.C.), Servei de Medicina Intensiva (M.P.G.-A.), and Servei d'Anestèsia i Reanimació (J.L.F.-C.), IMIM-Hospital del Mar, Barcelona; and Departament de Medicina (J.R., E.C.-G., A.R.-C., A.O.), Universitat Autònoma de Barcelona i DCEXS-Universitat Pompeu Fabra, Spain
| | - Jordi Jiménez-Conde
- From Servei de Neurologia (J.R., E.C.-G., A.R.-C., C.A.-G., E.G.-S., J.J.-C., C.S.-T., R.M.V.-H., A.O.), Departament J Merland de Neuroangiografia Terapèutica (L.G., E.V.), Servei de Neurocirurgia (G.C., G.V.-M.), Servei de Neuroradiologia (J.C.), Servei de Medicina Intensiva (M.P.G.-A.), and Servei d'Anestèsia i Reanimació (J.L.F.-C.), IMIM-Hospital del Mar, Barcelona; and Departament de Medicina (J.R., E.C.-G., A.R.-C., A.O.), Universitat Autònoma de Barcelona i DCEXS-Universitat Pompeu Fabra, Spain
| | - Carolina Soriano-Tárraga
- From Servei de Neurologia (J.R., E.C.-G., A.R.-C., C.A.-G., E.G.-S., J.J.-C., C.S.-T., R.M.V.-H., A.O.), Departament J Merland de Neuroangiografia Terapèutica (L.G., E.V.), Servei de Neurocirurgia (G.C., G.V.-M.), Servei de Neuroradiologia (J.C.), Servei de Medicina Intensiva (M.P.G.-A.), and Servei d'Anestèsia i Reanimació (J.L.F.-C.), IMIM-Hospital del Mar, Barcelona; and Departament de Medicina (J.R., E.C.-G., A.R.-C., A.O.), Universitat Autònoma de Barcelona i DCEXS-Universitat Pompeu Fabra, Spain
| | - Gloria Villalba-Martínez
- From Servei de Neurologia (J.R., E.C.-G., A.R.-C., C.A.-G., E.G.-S., J.J.-C., C.S.-T., R.M.V.-H., A.O.), Departament J Merland de Neuroangiografia Terapèutica (L.G., E.V.), Servei de Neurocirurgia (G.C., G.V.-M.), Servei de Neuroradiologia (J.C.), Servei de Medicina Intensiva (M.P.G.-A.), and Servei d'Anestèsia i Reanimació (J.L.F.-C.), IMIM-Hospital del Mar, Barcelona; and Departament de Medicina (J.R., E.C.-G., A.R.-C., A.O.), Universitat Autònoma de Barcelona i DCEXS-Universitat Pompeu Fabra, Spain
| | - Rosa M Vivanco-Hidalgo
- From Servei de Neurologia (J.R., E.C.-G., A.R.-C., C.A.-G., E.G.-S., J.J.-C., C.S.-T., R.M.V.-H., A.O.), Departament J Merland de Neuroangiografia Terapèutica (L.G., E.V.), Servei de Neurocirurgia (G.C., G.V.-M.), Servei de Neuroradiologia (J.C.), Servei de Medicina Intensiva (M.P.G.-A.), and Servei d'Anestèsia i Reanimació (J.L.F.-C.), IMIM-Hospital del Mar, Barcelona; and Departament de Medicina (J.R., E.C.-G., A.R.-C., A.O.), Universitat Autònoma de Barcelona i DCEXS-Universitat Pompeu Fabra, Spain
| | - Elio Vivas
- From Servei de Neurologia (J.R., E.C.-G., A.R.-C., C.A.-G., E.G.-S., J.J.-C., C.S.-T., R.M.V.-H., A.O.), Departament J Merland de Neuroangiografia Terapèutica (L.G., E.V.), Servei de Neurocirurgia (G.C., G.V.-M.), Servei de Neuroradiologia (J.C.), Servei de Medicina Intensiva (M.P.G.-A.), and Servei d'Anestèsia i Reanimació (J.L.F.-C.), IMIM-Hospital del Mar, Barcelona; and Departament de Medicina (J.R., E.C.-G., A.R.-C., A.O.), Universitat Autònoma de Barcelona i DCEXS-Universitat Pompeu Fabra, Spain
| | - Angel Ois
- From Servei de Neurologia (J.R., E.C.-G., A.R.-C., C.A.-G., E.G.-S., J.J.-C., C.S.-T., R.M.V.-H., A.O.), Departament J Merland de Neuroangiografia Terapèutica (L.G., E.V.), Servei de Neurocirurgia (G.C., G.V.-M.), Servei de Neuroradiologia (J.C.), Servei de Medicina Intensiva (M.P.G.-A.), and Servei d'Anestèsia i Reanimació (J.L.F.-C.), IMIM-Hospital del Mar, Barcelona; and Departament de Medicina (J.R., E.C.-G., A.R.-C., A.O.), Universitat Autònoma de Barcelona i DCEXS-Universitat Pompeu Fabra, Spain
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Huhtakangas J, Lehto H, Seppä K, Kivisaari R, Niemelä M, Hernesniemi J, Lehecka M. Long-Term Excess Mortality After Aneurysmal Subarachnoid Hemorrhage. Stroke 2015; 46:1813-8. [DOI: 10.1161/strokeaha.115.009288] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/05/2015] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
There is high case-fatality rate and loss of productive life-years related to aneurysmal subarachnoid hemorrhage (aSAH) but data on long-term survival of patients with aSAH are scarce. We aim to evaluate long-term excess mortality and related risk factors after an aSAH event.
Methods—
Survivors (n=3078) of aSAH who had survived for ≥1 year were reviewed for this retrospective follow-up study, which was conducted in the Department of Neurosurgery in Helsinki between 1980 and 2007. Follow-up started 1 year after the aSAH and continued until death or the end of 2012 (48 918 patient-years). Mortality and relative survival ratios were derived using a matched general population.
Results—
Survivors of aSAH after 20 years showed 17% excess mortality compared with the general population. Even young patients and patients with good recovery showed excess mortality. The highest excess mortality was among patients with multiple aneurysms, old age, poor preoperative clinical condition, conservative aneurysm treatment, and unfavorable clinical outcome at 1 year.
Conclusions—
Even after initially favorable recovery from an aSAH, survivors experience excess mortality in the long run in comparison to a matched general population. Cardiovascular disease at younger age and cerebrovascular events were overrepresented as causes of death, which indicates the importance of treatment of vascular risk factors. Young patients and patients with multiple aneurysms who are recovering from an aSAH should be followed-up and treated most actively.
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Affiliation(s)
- Justiina Huhtakangas
- From the Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland (J.H., H.L., R.K., M.N., J.H., M.L.); and Finnish Cancer Registry, Helsinki, Finland (K.S.)
| | - Hanna Lehto
- From the Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland (J.H., H.L., R.K., M.N., J.H., M.L.); and Finnish Cancer Registry, Helsinki, Finland (K.S.)
| | - Karri Seppä
- From the Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland (J.H., H.L., R.K., M.N., J.H., M.L.); and Finnish Cancer Registry, Helsinki, Finland (K.S.)
| | - Riku Kivisaari
- From the Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland (J.H., H.L., R.K., M.N., J.H., M.L.); and Finnish Cancer Registry, Helsinki, Finland (K.S.)
| | - Mika Niemelä
- From the Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland (J.H., H.L., R.K., M.N., J.H., M.L.); and Finnish Cancer Registry, Helsinki, Finland (K.S.)
| | - Juha Hernesniemi
- From the Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland (J.H., H.L., R.K., M.N., J.H., M.L.); and Finnish Cancer Registry, Helsinki, Finland (K.S.)
| | - Martin Lehecka
- From the Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland (J.H., H.L., R.K., M.N., J.H., M.L.); and Finnish Cancer Registry, Helsinki, Finland (K.S.)
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