Racial/ethnic differences in longitudinal risk of intracranial hemorrhage in brain arteriovenous malformation patients

• Published in: Stroke (1970) 2007-09, Vol.38 (9), p.2430-2437
• Main Authors: KIM, Helen, SIDNEY, Stephen, YOUNG, William L, MCCULLOCH, Charles E, TRUDY POON, K. Y, SINGH, Vineeta, CLAIBORNE JOHNSTON, S, KO, Nerissa U, ACHROL, Achal S, LAWTON, Michael T, HIGASHIDA, Randall T
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Continental Population Groups; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Injuries of the nervous system and the skull. Diseases due to physical agents; Intracranial Arteriovenous Malformations - complications; Intracranial Arteriovenous Malformations - ethnology; Intracranial Hemorrhages - ethnology; Intracranial Hemorrhages - etiology; Longitudinal Studies; Male; Medical sciences; Middle Aged; Multivariate Analysis; Nervous system (semeiology, syndromes); Neurology; Odds Ratio; Proportional Hazards Models; Prospective Studies; Regression Analysis; Risk Factors; Survival Rate; Traumas. Diseases due to physical agents; Vascular diseases and vascular malformations of the nervous system
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.107.485573

Race/ethnicity is associated with overall incidence of intracranial hemorrhage (ICH), but its impact in patients with brain arteriovenous malformation is unknown. We evaluated whether race/ethnicity was a risk factor for ICH in the natural course in a large, multiethnic cohort of patients with brain arteriovenous malformation followed longitudinally. Data were collected prospectively for patients with brain arteriovenous malformation evaluated at the University of California, San Francisco (n=436) and retrospectively through databases and chart review in the 20 hospitals of the Kaiser Permanente Medical Care Program (n=1028). Multivariate Cox regression was performed to assess the influence of race/ethnicity on subsequent ICH, adjusting for risk factors. Cases were censored at first treatment, loss to follow-up, or death. Average follow up was 4.7+/-8.0 years for Kaiser Permanente Medical Care Program patients and 2.8+/-7.3 years for University of California, San Francisco patients with no difference in time to ICH between cohorts (log rank P=0.57). The annualized 5-year ICH rate was 2.1% (3.7% for ruptured at presentation; 1.4% for unruptured). Initial ICH presentation (hazard ratio: 3.0, 95% CI: 1.9 to 4.9, P