Improved prognosis of thoracic aortic aneurysms. A population-based study

William Darrin Clouse, John W. Hallett, Hartzell V Schaff, Michelle M. Gayari, Duane M. Ilstrup, L. Joseph Melton

Research output: Contribution to journalArticle

318 Citations (Scopus)

Abstract

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%) 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). 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.

Original languageEnglish (US)
Pages (from-to)1926-1929
Number of pages4
JournalJournal of the American Medical Association
Volume280
Issue number22
StatePublished - Dec 9 1998

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Thoracic Aortic Aneurysm
Aneurysm
Rupture
Confidence Intervals
Population
Survival
Incidence
Abdominal Aortic Aneurysm
Echocardiography
Cohort Studies
Tomography
Magnetic Resonance Imaging
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Clouse, W. D., Hallett, J. W., Schaff, H. V., Gayari, M. M., Ilstrup, D. M., & Melton, L. J. (1998). Improved prognosis of thoracic aortic aneurysms. A population-based study. Journal of the American Medical Association, 280(22), 1926-1929.

Improved prognosis of thoracic aortic aneurysms. A population-based study. / Clouse, William Darrin; Hallett, John W.; Schaff, Hartzell V; Gayari, Michelle M.; Ilstrup, Duane M.; Melton, L. Joseph.

In: Journal of the American Medical Association, Vol. 280, No. 22, 09.12.1998, p. 1926-1929.

Research output: Contribution to journalArticle

Clouse, WD, Hallett, JW, Schaff, HV, Gayari, MM, Ilstrup, DM & Melton, LJ 1998, 'Improved prognosis of thoracic aortic aneurysms. A population-based study', Journal of the American Medical Association, vol. 280, no. 22, pp. 1926-1929.
Clouse WD, Hallett JW, Schaff HV, Gayari MM, Ilstrup DM, Melton LJ. Improved prognosis of thoracic aortic aneurysms. A population-based study. Journal of the American Medical Association. 1998 Dec 9;280(22):1926-1929.
Clouse, William Darrin ; Hallett, John W. ; Schaff, Hartzell V ; Gayari, Michelle M. ; Ilstrup, Duane M. ; Melton, L. Joseph. / Improved prognosis of thoracic aortic aneurysms. A population-based study. In: Journal of the American Medical Association. 1998 ; Vol. 280, No. 22. pp. 1926-1929.
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