Long-term vascular events after subarachnoid hemorrhage

Fernandez-Perez I, Giralt-Steinhauer E, Cuadrado-Godia E, Guimaraens L et al. J Neurol. 2022 Nov;269(11):6036-6042. doi: 10.1007/s00415-022-11255-z. Epub 2022 Jul 20. PMID: 35854138
Background: Spontaneous subarachnoid hemorrhage (SAH) long-term risk is not well known. Our aims are: describing long-term vascular event (VE) incidence rates in SAH survivors; describing VE: ischemic and/or hemorrhagic; identifying independent association of factors related to VE; and analyzing the usefulness of factors to increase predictive ability.
Methods: A prospective cohort study of consecutive patients admitted to Hospital del Mar with a diagnosis of SAH (n=566) between January 2007 and January 2020 was carried out. They were followed up until January 2021. The study endpoint was a new VE in the follow-up. We calculated both incidence rates and cumulative rates at 5 years. Cox regression survival models including vascular risk factors with and without specifc data of SAH disease were developed. We analyzed ROC curves of all multivariate models.
Results: The analyzed cohort included 423 non-fatal SAH cases. Total patient-years were 2468.16 years. The average followup was 70.03±43.14; range: 1–180 months. There were 49 VE detected in 47 patients, as 2 of them had more than 1 VE. Incidence rate was 0.020 events_per_patient/year, cumulative incidence at 5 years was 11.11%. The more frequent VE that we found were cerebrovascular (28/49), mainly ischemic (21/28). Disability after SAH and the presence of multiple aneurysms were independently associated with a VE risk and improved the predictive capacity of multivariate models (AUC 0.679 vs 0.764; p=0.0062).
Conclusions We reported a low vascular risk after SAH. We have shown the usefulness of SAH factors to identify patients with a higher risk of VE.
Funding: Supported in part by Spain’s Ministry of Health; FEDER, RICORDS-ICTUS(RD21/0006/0021) and PIO19/00011.