Extent of atherosclerosis and prognosis of patients with aneurysmal subarachnoid haemorrhage.
OBJECTIVE
Atherosclerosis impairs the endothelial dependent vasodilatation and may change the diameter and plasticity of cerebral vessels. The aim of this study was to investigate if an index of the occurrence of atherosclerosis is associated with the risk of delayed cerebral ischemia or poor outcome after subarachnoid haemorrhage.


METHODS
To assess the likelihood of atherosclerosis we used a modified version of the Framingham Heart Study Coronary Heart Disease Prediction Chart. The relation of this index to the occurrence of delayed cerebral ischemia was studied by means of survival analysis and to poor outcome by regression analysis. A multivariate analysis was used to investigate the independent contribution of the atherosclerosis index.


RESULTS
Three hundred and twenty three patients were retrieved from our database from the period 1997 to 2004. The index of atherosclerosis related to a good clinical condition on admission (p = 0.01). A high risk of atherosclerosis independently predicted poor outcome (OR 4.3; 95%CI 1.6-12). This was not caused by an increase in the occurrence of delayed cerebral ischemia (HR 1.1; 95%CI 0.6-2.1), but, in part, by a marked decrease in recurrent bleeding in patients with no or minor atherosclerosis.


CONCLUSIONS
An index of the occurrence of atherosclerosis is related to prognosis after subarachnoid haemorrhage. The use of the score may focus attention on patients at risk for poor outcome after subarachnoid haemorrhage.
van den Bergh
W M
WM
Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands. w.m.vandenbergh@umcutrecht.nl
Algra
A
A
Elias
R
R
Rinkel
G J E
GJ
D000328:Adult; D000367:Age Factors; D000368:Aged; D050197:Atherosclerosis / Q000150:complications* / Q000175:diagnosis; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000209:etiology*; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011859:Radiography; D012307:Risk Factors; D012737:Sex Factors; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D013997:Time Factors