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Multicenter Study
. 2013 Jan 29;80(5):481-6.
doi: 10.1212/WNL.0b013e31827f0fb5. Epub 2013 Jan 9.

Cause-specific mortality of 1-year survivors of subarachnoid hemorrhage

Miikka Korja  1 , Karri Silventoinen, Tiina Laatikainen, Pekka Jousilahti, Veikko Salomaa, Jaakko Kaprio
Affiliations
Multicenter Study

Cause-specific mortality of 1-year survivors of subarachnoid hemorrhage

Miikka Korja et al. Neurology. .

Abstract

Objective: To assess long-term, cause-specific mortality rates and rate ratios of the patients alive at 1 year after subarachnoid hemorrhage (SAH).

Methods: The population-based, prospective, cohort study with a nested case-control design consisted of 64,349 persons (aged 25-74 years at enrollment) who participated in the National FINRISK Study between 1972 and 2007. Four hundred thirty-seven SAH cases, 233 one-year SAH survivors, and their matched intrinsic controls were identified and followed up until the end of 2009 through the nationwide Finnish Causes of Death Register. All-cause mortality rates and rate ratios of the 1-year SAH survivors and controls were the main outcome measures.

Results: Eighty-eight (37.8%) of 233 one-year SAH survivors died during the total follow-up time of 2,487 person-years (median 8.6 years, range 0.1-35.8 years). The 1-year SAH survivors had a hazard ratio of 1.96 (95% confidence interval 1.57-2.47) for death compared with the matched general population with 10 controls for each SAH survivor. One-year SAH survivors had up to 31 additional deaths per 1,000 person-years compared with controls with minimal cerebrovascular risk factors. The higher long-term risk of death among SAH survivors was attributed solely to cerebrovascular diseases, and most important modifiable risk factors for death were smoking, high systolic blood pressure (≥ 159 mm Hg), and high cholesterol levels (≥ 7.07 mmol/L).

Conclusion: One-year SAH survivors have excess mortality, which is attributed to an exceptional risk of deadly cerebrovascular events. Aggressive post-SAH cerebrovascular risk factor intervention strategies are highly warranted.

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Figures

Figure 1
Figure 1. Kaplan-Meier survival analysis
A Kaplan-Meier survival analysis in which the general population controls (A) and 1-year subarachnoid hemorrhage (SAH) survivors (B) are divided into subgroups on the basis of risk factors: minimal risk factor subgroup (A1), Gaussian control population (A2), 1-year SAH survivors (A3), multiple risk factor subgroup (A4), 1-year SAH survivors with minimal risk factors (B1), Gaussian 1-year SAH survivors (B2), 1-year SAH survivors with multiple risk factors (B3). A1 and B1 = never smokers with systolic blood pressure (BP) <135 mm Hg and cholesterol levels <5.59 mmol/L. A4 and B3 = smokers with systolic BP ≥159 mm Hg or cholesterol levels ≥5.59 mmol/L.
Figure 2
Figure 2. Causes of death in 1-year survivors of subarachnoid hemorrhage (SAH) and matched general population controls
Number of deaths in each category is reported on the top of bars.
See this image and copyright information in PMC

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