title: Long-term outcome after aneurysmal subarachnoid hemorrhage-risks of vascular events, death from cancer and all-cause death.
abstract: Smoking and hypertension are risk factors for aneurysmal subarachnoid hemorrhage (aSAH), but also for other cardiovascular diseases and cancer. Few prospective data are available on the very long term risks of vascular diseases and vascular, cancer-related and overall death after aSAH. We determined vascular events and survival status in 1,765 patients with aSAH admitted to our center from 1985 to 2010. Cumulative risks were estimated with survival analysis. We compared risks of vascular, cancer-related and all-cause death with the general population with standardized mortality ratios (SMRs). Incidences of vascular events and death were compared with those after TIA/minor stroke. Conditional on surviving 3 months after aSAH, the risk of death was 8.7 % (95 % CI 7.3-10.1) within 5 years, 17.9 % (16.1-19.9) within 10 years, 29.5 % (27.3-31.8) within 15 years, and 43.6 % (41.2-46.1) within 20 years after SAH. The SMR for all-cause death was 1.8 (1.6-2.1), for vascular death 2.0 (95 % CI 1.6-2.5) and for cancer-related death 1.2 (0.9-1.5; sensitivity analysis 1.4; 95 % CI 1.1-1.8). The increased SMR for all-cause death persevered up to 20 years after aSAH. Compared with TIA/minor stroke patients, the age- and sex-adjusted cumulative incidence on vascular events was lower for aSAH patients [hazard ratio (HR) 0.48; 95 % CI 0.40-0.57); the HR for all-cause death was 0.96 (95 % CI 0.84-1.10). After aSAH, risks of vascular events and death, and probably also that of cancer-related death, are higher than in the general population. Although the long-term risk of vascular events was lower in aSAH patients than in TIA/minor stroke patients, the risk of death was similar.
authors.affiliation: Department of Neurology and Neurosurgery, UMC Utrecht Stroke Center, The Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands, d.nieuwkamp@umcutrecht.nl.
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Nieuwkamp
authors.forename: Arno
authors.initials: A
authors.lastname: de Wilde
authors.forename: Marieke J H
authors.initials: MJ
authors.lastname: Wermer
authors.forename: Ale
authors.initials: A
authors.lastname: Algra
authors.forename: Gabriël J E
authors.initials: GJ
authors.lastname: Rinkel
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications / Q000401:mortality; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality*; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000401:mortality*; D016019:Survival Analysis; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000401:mortality*; D055815:Young Adult