Endovascular strategy or open repair for ruptured abdominal aortic aneurysm: one-year outcomes from the IMPROVE randomized trial
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Published version
Author(s)
Type
Journal Article
Abstract
AIMS: To report the longer term outcomes following either a strategy of endovascular repair first or open repair of ruptured abdominal aortic aneurysm, which are necessary for both patient and clinical decision-making. METHODS AND RESULTS: This pragmatic multicentre (29 UK and 1 Canada) trial randomized 613 patients with a clinical diagnosis of ruptured aneurysm; 316 to an endovascular first strategy (if aortic morphology is suitable, open repair if not) and 297 to open repair. The principal 1-year outcome was mortality; secondary outcomes were re-interventions, hospital discharge, health-related quality-of-life (QoL) (EQ-5D), costs, Quality-Adjusted-Life-Years (QALYs), and cost-effectiveness [incremental net benefit (INB)]. At 1 year, all-cause mortality was 41.1% for the endovascular strategy group and 45.1% for the open repair group, odds ratio 0.85 [95% confidence interval (CI) 0.62, 1.17], P = 0.325, with similar re-intervention rates in each group. The endovascular strategy group and open repair groups had average total hospital stays of 17 and 26 days, respectively, P < 0.001. Patients surviving rupture had higher average EQ-5D utility scores in the endovascular strategy vs. open repair groups, mean differences 0.087 (95% CI 0.017, 0.158), 0.068 (95% CI -0.004, 0.140) at 3 and 12 months, respectively. There were indications that QALYs were higher and costs lower for the endovascular first strategy, combining to give an INB of £3877 (95% CI £253, £7408) or €4356 (95% CI €284, €8323). CONCLUSION: An endovascular first strategy for management of ruptured aneurysms does not offer a survival benefit over 1 year but offers patients faster discharge with better QoL and is cost-effective. CLINICAL TRIAL REGISTRATION: ISRCTN 48334791.
Date Issued
2015-04-07
Online Publication Date
2015-04-07
Date Acceptance
2015-03-26
ISSN
1522-9645
Publisher
Oxford University Press (OUP)
Start Page
2061
End Page
2069
Journal / Book Title
European Heart Journal
Volume
36
Issue
31
Copyright Statement
© The Authors 2015. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.
Source Database
pubmed
Sponsor
Department of Health
National Institute for Health Research Health Technology Assessment Programme
Identifier
https://academic.oup.com/eurheartj/article/36/31/2061/2398075
Grant Number
07/37/64
HTA project 07/37/64
Subjects
Aneurysm
Aorta
Cost-effectiveness
Rupture
Stent grafts
Surgery
Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
Aneurysm
Aorta
Rupture
Surgery
Stent grafts
Cost-effectiveness
COST-EFFECTIVENESS
OPEN SURGERY
MORTALITY
SURVIVAL
LESSONS
UTILITY
Aneurysm
Aorta
Cost-effectiveness
Rupture
Stent grafts
Surgery
IMPROVE Trial Investigators
Cardiovascular System & Hematology
1102 Cardiorespiratory Medicine and Haematology
1103 Clinical Sciences
Publication Status
Published
Date Publish Online
2015-04-08