Open AccessAssociation of Aortic Aneurysms and Dissections With Subarachnoid Hemorrhage
Author(s) -
AlKawaz Mais,
Kamel Hooman,
Murthy Santosh B.,
Merkler Alexander E.
Publication year - 2019
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.119.013456
Subject(s) - medicine , aneurysm , subarachnoid hemorrhage , aortic dissection , stroke (engine) , aortic aneurysm , dissection (medical) , surgery , incidence (geometry) , cardiology , aorta , proportional hazards model , aortic rupture , hazard ratio , radiology , confidence interval , mechanical engineering , physics , optics , engineering
Background It is uncertain whether aortic diseases, such as aneurysm and dissection, are associated with intracranial aneurysm formation and aneurysmal subarachnoid hemorrhage ( SAH ). Methods and Results We used data on claims between 2008 and 2015 from a nationally representative 5% sample of Medicare beneficiaries. Our exposure variable was hospitalization with an unruptured or ruptured aortic aneurysm or aortic dissection. The outcome was nontraumatic SAH . Variables were ascertained by International Classification of Diseases, Ninth Revision, Clinical Modification ( ICD ‐9‐ CM ), diagnosis codes. Survival statistics were used to calculate incidence rates. Cox proportional hazards analysis was used to examine the association between aortic aneurysm/dissection and SAH while adjusting for demographics, vascular risk factors, and Charlson comorbidities. Among 1 781 917 beneficiaries, 32 551 (1.8%) had a documented aortic aneurysm or dissection. During 4.6±2.2 years of follow‐up, 2538 patients (0.14%) developed a nontraumatic SAH . The incidence of SAH was 9 (95% CI , 7–11) per 10 000 patients per year in those with aortic aneurysm/dissection compared with 3 (95% CI , 3–3) per 10 000 patients per year in those without aortic aneurysm/dissection. After adjustment for demographics, stroke risk factors, and Charlson comorbidities, patients with aortic aneurysm/dissection faced an increased risk of SAH (hazard ratio, 1.4; 95% CI , 1.02–1.9; P =0.04). Conclusions In a nationally representative sample of Medicare beneficiaries, aortic aneurysm/dissection was associated with an increased risk of nontraumatic SAH .