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Accès ouvert déclaré 2017 review

Meta-analysis of individual-patient data from EVAR-1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years

431Citations signalées — pas une note de qualité
118Institutions déclarées
11Pays d’affiliation déclarés

Résumé fourni par la source

BACKGROUND: The erosion of the early mortality advantage of elective endovascular aneurysm repair (EVAR) compared with open repair of abdominal aortic aneurysm remains without a satisfactory explanation. METHODS: An individual-patient data meta-analysis of four multicentre randomized trials of EVAR versus open repair was conducted to a prespecified analysis plan, reporting on mortality, aneurysm-related mortality and reintervention. RESULTS: The analysis included 2783 patients, with 14 245 person-years of follow-up (median 5·5 years). Early (0-6 months after randomization) mortality was lower in the EVAR groups (46 of 1393 versus 73 of 1390 deaths; pooled hazard ratio 0·61, 95 per cent c.i. 0·42 to 0·89; P = 0·010), primarily because 30-day operative mortality was lower in the EVAR groups (16 deaths versus 40 for open repair; pooled odds ratio 0·40, 95 per cent c.i. 0·22 to 0·74). Later (within 3 years) the survival curves converged, remaining converged to 8 years. Beyond 3 years, aneurysm-related mortality was significantly higher in the EVAR groups (19 deaths versus 3 for open repair; pooled hazard ratio 5·16, 1·49 to 17·89; P = 0·010). Patients with moderate renal dysfunction or previous coronary artery disease had no early survival advantage under EVAR. Those with peripheral artery disease had lower mortality under open repair (39 deaths versus 62 for EVAR; P = 0·022) in the period from 6 months to 4 years after randomization. CONCLUSION: The early survival advantage in the EVAR group, and its subsequent erosion, were confirmed. Over 5 years, patients of marginal fitness had no early survival advantage from EVAR compared with open repair. Aneurysm-related mortality and patients with low ankle : brachial pressure index contributed to the erosion of the early survival advantage for the EVAR group. Trial registration numbers: EVAR-1, ISRCTN55703451; DREAM (Dutch Randomized Endovascular Aneurysm Management), NCT00421330; ACE (Anévrysme de l'aorte abdominale, Chirurgie versus Endoprothèse), NCT00224718; OVER (Open Versus Endovascular Repair Trial for Abdominal Aortic Aneurysms), NCT00094575.

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Contrôle bibliographique ouvert

DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.

Titre Crossref
Meta-analysis of individual-patient data from EVAR-1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years
Date Crossref
01/02/2017
Éditeur
Oxford University Press (OUP)
Type
journal-article

Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude et ne compte pas comme une seconde source scientifique indépendante.

Institutions déclarées

Imperial College LondonUniversity of CambridgeUniversity Medical Center UtrechtAmsterdam UMC Location Vrije Universiteit AmsterdamVA Connecticut Healthcare SystemMinneapolis VA Medical CenterUniversité Paris-Est CréteilHôpitaux Universitaires Henri-MondorCharing Cross HospitalNorthern General HospitalUniversity of LiverpoolRoyal Liverpool University HospitalFreeman HospitalQueen's Medical CentreUniversity of UlsterBelfast City HospitalHeartlands HospitalRoyal Bournemouth HospitalCountess of Chester HospitalUniversity Hospital CoventryDerriford HospitalGartnavel General HospitalGlasgow Royal InfirmarySt Thomas' HospitalSt. Thomas HospitalHull Royal InfirmaryJames Cook University HospitalKent and Canterbury HospitalRoyal Lancaster InfirmaryLeeds General InfirmarySt James's University HospitalSt. James's HospitalLeicester Royal InfirmaryManchester Royal InfirmaryNew Cross HospitalQueen Elizabeth HospitalRoyal Cornwall HospitalThe Royal Free HospitalUniversity College LondonRoyal Gwent HospitalRoyal London HospitalRoyal Shrewsbury HospitalRoyal Sussex County HospitalRoyal United HospitalSouthampton General HospitalSelly Oak HospitalSt George's HospitalUniversity College HospitalRadboud University NijmegenCatharina ZiekenhuisErasmus University RotterdamAmsterdam UMC Location University of AmsterdamVrije Universiteit AmsterdamSint Franciscus GasthuisRijnstate HospitalAlbert Schweitzer HospitalAtrium Medical (Australia)GGD Rotterdam-RijnmondJeroen Bosch ZiekenhuisSt. Elisabeth HospitalMáxima Medisch CentrumOLVGMeander Medisch CentrumFranciscus VlietlandRadboud University Medical CenterMartini ZiekenhuisMedisch Centrum HaaglandenZiekenhuis BernhovenLeiden University Medical CenterMaastricht University Medical CentreAZ TurnhoutAntwerp University HospitalGhent University HospitalSeattle UniversityEast Orange VA Medical CenterThe Coordinating CenterSMART ReadingNational Transportation Safety BoardUniversity of BaltimoreDetroit R&D (United States)Denver School of NursingDurham Technical Community CollegeGainesville Obstetrics & GynecologyEdward Hines, Jr. VA HospitalIndianapolis ZooIowa City Public LibraryKentucky Educational TelevisionArkansas Department of AgricultureCalifornia State University, Long BeachMemphis Health CenterMinneapolis Institute of ArtsUniversity of Nebraska at OmahaPalo Alto InstitutePhiladelphia UniversityOregon Medical Research CenterAdventHealth TampaWest Los Angeles CollegeHôpital Européen Georges-PompidouHôpital EuropéenHôpital NordHôpital Charles-NicolleCentre Hospitalier Universitaire de ToursHôpital Saint JosephCentre Hospitalier Universitaire d'AngersClinique Mutualiste de l'EstuaireHôpital PontchaillouLille’s Cardiology HospitalHôpital LaennecHôpital NOVOCentre Hospitalier de ValenciennesNouvelles Cliniques NantaisesClinique Saint-JosephClinique PasteurHôpital de la TimoneHôpital Saint RochHôpital Maison BlancheUniversité de PoitiersAddenbrooke's Hospital

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Sujets associés

Aortic aneurysm repair treatmentsPeripheral Artery Disease ManagementCardiac, Anesthesia and Surgical Outcomes

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