Department of Neurosurgery, Tianjin Medical University General Hospital, China (Y.Y., B.W., C.P., Y.Z., J.L., J.Z., X.Y.).
Department of Neurosurgery, Xingtai People's Hospital, China (X.G., Z.L.).
Stroke. 2023 Aug;54(8):2087-2095. doi: 10.1161/STROKEAHA.123.042530. Epub 2023 Jun 12.
The current understanding of untreated ruptured intracranial aneurysms has been limited by study design and inaccurate patient data. Multicenter clinical registry studies on untreated ruptured intracranial aneurysms in Chinese patients are scarce. We aimed to calculate the mortality of patients with untreated ruptured intracranial aneurysms in a current, clearly defined hospital cohort in China, with emphasis on mortality predictors over a 2-year period.
Patients with saccular untreated ruptured intracranial aneurysms were identified from the Chinese Multicenter Cerebral Aneurysm Database, a multicenter, prospective, observational database registered in China, which involved 32 tertiary medical centers covering 4 northern Chinese provincial regions. Patients with intracranial aneurysms, regardless of ruptured status, shape, age, or comorbidities, were consecutively included in 12 of 32 medical centers between 2017 and 2020. Survival probabilities were computed using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were conducted to determine the risk factors for the cumulative 2-year mortality. We analyzed the reasons for treatment decisions stratified by demographic characteristics and clinical features.
For 941 enrolled patients, 58.6% of patients died within 1 month of symptom onset; and 68.1% within 2 years. 98 patients underwent surgical repair during follow-up. Multivariate Cox regression analysis identified Hunt and Hess grades 3 to 5 (hazard ratio, 1.54 [95% CI, 1.01-2.35]; =0.047), loss of consciousness at symptom onset (hazard ratio, 1.56 [95% CI, 1.18-2.07]; =0.002), and largest aneurysm size of ≥5 mm (hazard ratio, 1.29 [95% CI, 1.05-1.59]; =0.014) as mortality predictors during the 2-year follow-up. Among patients who were successfully followed up, 42.6% (280) of them refused surgical treatment.
Patients with poor Hunt and Hess grades, loss of consciousness at symptom onset, or largest aneurysms ≥5 mm in size showed a high mortality rate. A high number of treatment refusals was present in this study. These findings have implications for medical insurance policy, doctor-patient communication, and popular science education.
由于研究设计和患者数据不准确，目前对未经治疗的破裂颅内动脉瘤的认识有限。在中国，针对未经治疗的破裂颅内动脉瘤的多中心临床登记研究很少。我们旨在计算中国当前明确定义的医院队列中未经治疗的破裂颅内动脉瘤患者的死亡率，并重点关注 2 年内的死亡率预测因素。
从中国多中心颅内动脉瘤数据库中确定了囊状未破裂颅内动脉瘤患者，该数据库是一个在中国注册的多中心前瞻性观察性数据库，涉及 32 个三级医疗中心，涵盖中国北部 4 个省级地区。在 2017 年至 2020 年期间，32 个医疗中心中的 12 个连续纳入了颅内动脉瘤患者，无论破裂状态、形状、年龄或合并症如何。使用 Kaplan-Meier 方法计算生存概率。进行单变量和多变量 Cox 回归分析，以确定累积 2 年死亡率的危险因素。我们根据人口统计学特征和临床特征对治疗决策的原因进行了分层分析。
在纳入的 941 名患者中，58.6%的患者在症状出现后 1 个月内死亡，68.1%的患者在 2 年内死亡。98 名患者在随访期间接受了手术治疗。多变量 Cox 回归分析确定了 Hunt 和 Hess 分级 3 至 5 级（危险比，1.54 [95%可信区间，1.01-2.35]；=0.047）、症状发作时意识丧失（危险比，1.56 [95%可信区间，1.18-2.07]；=0.002）和最大动脉瘤大小≥5mm（危险比，1.29 [95%可信区间，1.05-1.59]；=0.014）是 2 年随访期间的死亡率预测因素。在成功随访的患者中，有 42.6%（280 人）拒绝手术治疗。
Hunt 和 Hess 分级差、症状发作时意识丧失或最大动脉瘤大小≥5mm 的患者死亡率较高。本研究中存在大量治疗拒绝的情况。这些发现对医疗保险政策、医患沟通和科普教育都有影响。
