Improved prognosis of thoracic aortic aneurysms - A population-based study
Improved prognosis of thoracic aortic aneurysms - A population-based study
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DOI：
10.1001/jama.280.22.1926
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发表时间：
1998-12-09
影响因子：
120.7
通讯作者：
Schaff, HV
中科院分区：
文献类型：
--
作者：
Clouse, WD;Hallett, JW;Schaff, HV
背景.-通过增加使用计算机断层扫描、超声心动图和磁共振成像来管理偶然发现的胸主动脉瘤是有问题的，特别是在老年人中。目的.-确定以前报道的胸主动脉瘤患者的不良预后是否已经随着更好的药物治疗和改进的手术技术而改变，这些治疗和手术技术现在可应用于动脉瘤的治疗。设计。-基于人群的队列研究。设置和患者。-所有1980 年至 1994 年间，明尼苏达州奥姆斯特德县居民中 133 名被诊断为退行性胸主动脉瘤的患者与先前报告的 1951 年至 1980 年间的类似患者队列进行比较。主要结果指标。-主要临床终点是发病率、累积破裂风险、破裂风险与动脉瘤大小的关系以及生存率。结果。-与腹主动脉瘤相比动脉瘤主要影响男性，51% 的胸主动脉瘤是在识别时比男性年龄大得多的女性中发现的（平均年龄分别为 75.9 岁和 62.8 岁；P = .01）。 1980 年至 1994 年间，总发病率为每 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，破裂的累积风险为 20%。 79% 的破裂发生在女性 (P = .01)。作为识别时动脉瘤大小的函数，直径小于 4 cm 的动脉瘤的 5 年破裂风险为 0%，4 至 5.9 cm 的动脉瘤为 16%（95% CI，4%-28%），6 cm 或以上的动脉瘤为 31%（95% CI，5%-56%）。 1980 年至 1994 年间，总体 5 年生存率提高至 56%（95% CI，48%-66%），而 1951 年至 1980 年期间仅为 19%（P < .01）。结论：在这一人群中，老年女性在所有临床公认的胸主动脉瘤患者中所占比例不断增加，并且构成动脉瘤最终破裂的患者的大多数。过去 15 年中，胸主动脉瘤的总体生存率显着提高。
Context.-Managing thoracic aortic aneurysms identified incidentally by increased use of computed tomography, echocardiography, and magnetic resonance imaging is problematic, especially in the elderly.Objective.-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.Design.-Population-based cohort study.Setting and Patients.-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.Main Outcome Measures.-The primary clinical end points were incidence, cumulative rupture risk, rupture risk as a function of aneurysm size, and survival.Results.-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 100 000 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%) fd 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).Conclusions.-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.