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(Stroke. 2001;32:2850.)
© 2001 American Heart Association, Inc.

Original Contributions

Evidence for Excess Long-Term Mortality After Treated Subarachnoid Hemorrhage

Antti Ronkainen, MD, PhD; Minna Niskanen, MD, PhD; Jaakko Rinne, MD, PhD; Timo Koivisto, MD; Juha Hernesniemi, MD, PhD Matti Vapalahti, MD, PhD

From the Department of Neurosurgery (A.R., J.R., T.K., M.V.) and Department of Anaesthesiology and Intensive Care (M.N.), University Hospital of Kuopio, Kuopio, Finland, and Department of Neurosurgery (J.H.), University Hospital of Helsinki, Helsinki, Finland.

Correspondence to Dr Antti Ronkainen, Department of Neurosurgery, University Hospital of Kuopio, PL 1777, FIN-70210 Kuopio, Finland. E-mail antti.ronkainen{at}kuh.fi

Background and Purpose— The purpose of this study was to examine the long-term mortality rate of patients with aneurysmal subarachnoid hemorrhage (SAH) compared with that of the general population.

Methods— Aneurysmal SAH patients who were treated for ruptured aneurysm from 1977 through 1998 in a tertiary referral center (n=1537) were followed up for a median of 7.5 years. Dates and causes of death were determined. Standardized mortality ratios (observed/expected deaths) according to age, sex, and Glasgow Outcome Scale at 12 months after surgery were calculated.

Results— The mortality rate among patients with good recovery at 12 months was twice that of the general population. The excess mortality appeared to be most evident in younger age groups. Cerebrovascular and cardiovascular diseases were the principal causes of premature death. The result was similar among patients without preexisting cardiovascular diseases at the time of SAH.

Conclusions— Aneurysmal SAH patients have an excess mortality rate even after successful treatment of ruptured aneurysms. Therefore, aneurysmal SAH should be viewed more as one aspect of a chronic general vascular disease, and more attention should be given to treatment of risk factors and long-term follow-up of these patients.

Key Words: intracranial aneurysm • mortality • outcome • subarachnoid hemorrhage • urban population

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