Clouse W D, Hallett J W, Schaff H V, Gayari M M, Ilstrup D M, Melton L J
Division of Vascular Surgery, Mayo Clinic and Mayo Medical School, Rochester, Minn 55905, USA.
JAMA. 1998 Dec 9;280(22):1926-9. doi: 10.1001/jama.280.22.1926.
Managing thoracic aortic aneurysms identified incidentally by increased use of computed tomography, echocardiography, and magnetic resonance imaging is problematic, especially in the elderly.
To ascertain whether the previously reported poor prognosis for individuals with thoracic aortic aneurysms has changed with better medical therapies and improved surgical techniques that can now be applied to aneurysm management.
Population-based cohort study.
All 133 patients with the diagnosis of degenerative thoracic aortic aneurysms among Olmsted County, Minnesota, residents between 1980 and 1994 compared with a previously reported cohort of similar patients between 1951 and 1980.
The primary clinical end points were incidence, cumulative rupture risk, rupture risk as a function of aneurysm size, and survival.
In contrast to abdominal aortic aneurysms, for which men are affected predominately, 51% of thoracic aortic aneurysms were identified in women who were considerably older at recognition than men (mean age, 75.9 vs 62.8 years, respectively; P= .01). The overall incidence rate of 10.4 per 100000 person-years (95% confidence interval [CI], 8.6-12.2) between 1980 and 1994 was more than 3-fold higher than the rate from 1951 to 1980. The cumulative risk of rupture was 20% after 5 years. Seventy-nine percent of ruptures occurred in women (P= .01). The 5-year risk of rupture as a function of aneurysm size at recognition was 0% for aneurysms less than 4 cm in diameter, 16% (95% CI, 4%-28%) for those 4 to 5.9 cm, and 31% (95% CI, 5%-56%) for aneurysms 6 cm or more. Overall 5-year survival improved to 56% (95% CI, 48%-66%) between 1980 and 1994 compared with only 19% between 1951 and 1980 (P<.01).
In this population, elderly women represent an increasing portion of all patients with clinically recognized thoracic aortic aneurysms and constitute the majority of patients whose aneurysm eventually ruptures. Overall survival for thoracic aortic aneurysms has improved significantly in the past 15 years.
随着计算机断层扫描、超声心动图和磁共振成像的使用增加，偶然发现的胸主动脉瘤的管理存在问题，尤其是在老年人中。
确定先前报道的胸主动脉瘤患者预后不良的情况是否因现在可应用于动脉瘤管理的更好的药物治疗和改进的手术技术而有所改变。
基于人群的队列研究。
明尼苏达州奥尔姆斯特德县1980年至1994年间所有133例诊断为退行性胸主动脉瘤的居民，并与先前报道的1951年至1980年间的类似患者队列进行比较。
主要临床终点为发病率、累积破裂风险、破裂风险与动脉瘤大小的关系以及生存率。
与主要影响男性的腹主动脉瘤不同，51%的胸主动脉瘤在女性中被发现，女性被发现时的年龄比男性大得多（平均年龄分别为75.9岁和62.8岁；P = 0.01）。1980年至1994年间的总体发病率为每10万人年10.4例（95%置信区间[CI]，8.6 - 12.2），比1951年至1980年的发病率高出3倍多。5年后的累积破裂风险为20%。79%的破裂发生在女性中（P = 0.01）。根据发现时动脉瘤大小计算的5年破裂风险，直径小于4 cm的动脉瘤为0%，4至5.9 cm的动脉瘤为16%（95% CI，4% - 28%），6 cm或更大的动脉瘤为31%（95% CI，5% - 56%）。与1951年至1980年间仅19%相比，1980年至1994年间总体5年生存率提高到56%（95% CI，48% - 66%）（P < 0.01）。
在这一人群中，老年女性在所有临床诊断的胸主动脉瘤患者中所占比例越来越大，并且构成了动脉瘤最终破裂患者的大多数。在过去15年中，胸主动脉瘤的总体生存率有了显著提高。
