Endovascular strategy or open repair for ruptured abdominal aortic aneurysm: One-year outcomes from the IMPROVE randomized trial

Bruce Braithwaite; Roger M. Greenhalgh; Richard Grieve; Tajek B. Hassan; Fionna Moore; Anthony A. Nicholson; Chee V. Soong; Francine Heatley; Aisha Anjum; Gosia Kalinowska; Manuel Gomes; Janet T. Powell; Robert Hinchliffe; Michael Sweeting; Matt M. Thompson; Simon G. Thompson; Pinar Ulug; Ian Roberts; Peter R.F. Bell; Anne Cheetham; Jenny Stephany; Alison W. Halliday; Charles Warlow; Peter Lamont; Jonathan Moss; Jan Tijssen; Ray Ashleigh; Matthew Thompson; Luke Thompson; Nicholas J. Cheshire; Jonathan R. Boyle; Ferdinand Serracino-Inglott; Robert J. Hinchliffe; Rachel Bell; Noel Wilson; Matt Bown; Martin Dennis; Meryl Davis; Simon Howell; Michael G. Wyatt; Domenico Valenti; Paul Bachoo; Paul Walker; Shane MacSweeney; Jonathan N. Davies; Dynesh Rittoo; Simon D. Parvin; Waquar Yusuf; Colin Nice; Ian Chetter; Adam Howard; Patrick Chong; Raj Bhat; David McLain; Andrew Gordon; Ian Lane; Simon Hobbs; Woolagasen Pillay; Timothy Rowlands; Amin El-Tahir; John Asquith; Steve Cavanagh; Luc Dubois; Thomas L. Forbes; Emily Ashworth; Sara Baker; Hashem Barakat; Claire Brady; Joanne Brown; Christine Bufton; Tina Chance; Angela Chrisopoulou; Marie Cockell; Andrea Croucher; Leela Dabee; Nikki Dewhirst; Jo Evans; Andy Gibson; Siobhan Gorst; Moira Gough; Lynne Graves; Michelle Griffin; Josie Hatfield; Florence Hogg; Susannah Howard; Cián Hughes; David Metcalfe; Michelle Lapworth; Ian Massey; Teresa Novick; Gareth Owen; Noala Parr; David Pintar; Sarah Spencer; Claire Thomson; Orla Thunder; Tom Wallace; Sue Ward; Vera Wealleans; Lesley Wilson; Janet Woods; Ting Zheng

doi:10.1093/eurheartj/ehv125

Endovascular strategy or open repair for ruptured abdominal aortic aneurysm: One-year outcomes from the IMPROVE randomized trial

Bruce Braithwaite, Roger M. Greenhalgh, Richard Grieve, Tajek B. Hassan, Fionna Moore, Anthony A. Nicholson, Chee V. Soong, Francine Heatley, Aisha Anjum, Gosia Kalinowska, Manuel Gomes, Janet T. Powell, Robert Hinchliffe, Michael Sweeting, Matt M. Thompson, Simon G. Thompson, Pinar Ulug, Ian Roberts, Peter R.F. Bell, Anne CheethamJenny Stephany, Alison W. Halliday, Charles Warlow, Peter Lamont, Jonathan Moss, Jan Tijssen, Ray Ashleigh, Matthew Thompson, Luke Thompson, Nicholas J. Cheshire, Jonathan R. Boyle, Ferdinand Serracino-Inglott, Robert J. Hinchliffe, Rachel Bell, Noel Wilson, Matt Bown, Martin Dennis, Meryl Davis, Simon Howell, Michael G. Wyatt, Domenico Valenti, Paul Bachoo, Paul Walker, Shane MacSweeney, Jonathan N. Davies, Dynesh Rittoo, Simon D. Parvin, Waquar Yusuf, Colin Nice, Ian Chetter, Adam Howard, Patrick Chong, Raj Bhat, David McLain, Andrew Gordon, Ian Lane, Simon Hobbs, Woolagasen Pillay, Timothy Rowlands, Amin El-Tahir, John Asquith, Steve Cavanagh, Luc Dubois, Thomas L. Forbes, Emily Ashworth, Sara Baker, Hashem Barakat, Claire Brady, Joanne Brown, Christine Bufton, Tina Chance, Angela Chrisopoulou, Marie Cockell, Andrea Croucher, Leela Dabee, Nikki Dewhirst, Jo Evans, Andy Gibson, Siobhan Gorst, Moira Gough, Lynne Graves, Michelle Griffin, Josie Hatfield, Florence Hogg, Susannah Howard, Cián Hughes, David Metcalfe, Michelle Lapworth, Ian Massey, Teresa Novick, Gareth Owen, Noala Parr, David Pintar, Sarah Spencer, Claire Thomson, Orla Thunder, Tom Wallace, Sue Ward, Vera Wealleans, Lesley Wilson, Janet Woods, Ting Zheng

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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.

Original language	English
Pages (from-to)	2061-2069
Number of pages	9
Journal	European Heart Journal
Volume	36
Issue number	31
DOIs	https://doi.org/10.1093/eurheartj/ehv125
State	Published - Aug 14 2015
Externally published	Yes

Keywords

Aneurysm
Aorta
Cost-effectiveness
Rupture
Stent grafts
Surgery

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10.1093/eurheartj/ehv125

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Braithwaite, B., Greenhalgh, R. M., Grieve, R., Hassan, T. B., Moore, F., Nicholson, A. A., Soong, C. V., Heatley, F., Anjum, A., Kalinowska, G., Gomes, M., Powell, J. T., Hinchliffe, R., Sweeting, M., Thompson, M. M., Thompson, S. G., Ulug, P., Roberts, I., Bell, P. R. F., ... Zheng, T. (2015). Endovascular strategy or open repair for ruptured abdominal aortic aneurysm: One-year outcomes from the IMPROVE randomized trial. European Heart Journal, 36(31), 2061-2069. https://doi.org/10.1093/eurheartj/ehv125

@article{b73564cddc314dc9a54a89a30dffdc4a,

title = "Endovascular strategy or open repair for ruptured abdominal aortic aneurysm: One-year outcomes from the IMPROVE randomized trial",

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.",

keywords = "Aneurysm, Aorta, Cost-effectiveness, Rupture, Stent grafts, Surgery",

author = "Bruce Braithwaite and Greenhalgh, {Roger M.} and Richard Grieve and Hassan, {Tajek B.} and Fionna Moore and Nicholson, {Anthony A.} and Soong, {Chee V.} and Francine Heatley and Aisha Anjum and Gosia Kalinowska and Manuel Gomes and Powell, {Janet T.} and Robert Hinchliffe and Michael Sweeting and Thompson, {Matt M.} and Thompson, {Simon G.} and Pinar Ulug and Ian Roberts and Bell, {Peter R.F.} and Anne Cheetham and Jenny Stephany and Halliday, {Alison W.} and Charles Warlow and Peter Lamont and Jonathan Moss and Jan Tijssen and Ray Ashleigh and Matthew Thompson and Luke Thompson and Cheshire, {Nicholas J.} and Boyle, {Jonathan R.} and Ferdinand Serracino-Inglott and Hinchliffe, {Robert J.} and Rachel Bell and Noel Wilson and Matt Bown and Martin Dennis and Meryl Davis and Simon Howell and Wyatt, {Michael G.} and Domenico Valenti and Paul Bachoo and Paul Walker and Shane MacSweeney and Davies, {Jonathan N.} and Dynesh Rittoo and Parvin, {Simon D.} and Waquar Yusuf and Colin Nice and Ian Chetter and Adam Howard and Patrick Chong and Raj Bhat and David McLain and Andrew Gordon and Ian Lane and Simon Hobbs and Woolagasen Pillay and Timothy Rowlands and Amin El-Tahir and John Asquith and Steve Cavanagh and Luc Dubois and Forbes, {Thomas L.} and Emily Ashworth and Sara Baker and Hashem Barakat and Claire Brady and Joanne Brown and Christine Bufton and Tina Chance and Angela Chrisopoulou and Marie Cockell and Andrea Croucher and Leela Dabee and Nikki Dewhirst and Jo Evans and Andy Gibson and Siobhan Gorst and Moira Gough and Lynne Graves and Michelle Griffin and Josie Hatfield and Florence Hogg and Susannah Howard and Ci{\'a}n Hughes and David Metcalfe and Michelle Lapworth and Ian Massey and Teresa Novick and Gareth Owen and Noala Parr and David Pintar and Sarah Spencer and Claire Thomson and Orla Thunder and Tom Wallace and Sue Ward and Vera Wealleans and Lesley Wilson and Janet Woods and Ting Zheng",

note = "Publisher Copyright: {\textcopyright} 2015 The Author.",

year = "2015",

month = aug,

day = "14",

doi = "10.1093/eurheartj/ehv125",

language = "English",

volume = "36",

pages = "2061--2069",

journal = "European Heart Journal",

issn = "0195-668X",

number = "31",

}

Braithwaite, B, Greenhalgh, RM, Grieve, R, Hassan, TB, Moore, F, Nicholson, AA, Soong, CV, Heatley, F, Anjum, A, Kalinowska, G, Gomes, M, Powell, JT, Hinchliffe, R, Sweeting, M, Thompson, MM, Thompson, SG, Ulug, P, Roberts, I, Bell, PRF, Cheetham, A, Stephany, J, Halliday, AW, Warlow, C, Lamont, P, Moss, J, Tijssen, J, Ashleigh, R, Thompson, M, Thompson, L, Cheshire, NJ, Boyle, JR, Serracino-Inglott, F, Hinchliffe, RJ, Bell, R, Wilson, N, Bown, M, Dennis, M, Davis, M, Howell, S, Wyatt, MG, Valenti, D, Bachoo, P, Walker, P, MacSweeney, S, Davies, JN, Rittoo, D, Parvin, SD, Yusuf, W, Nice, C, Chetter, I, Howard, A, Chong, P, Bhat, R, McLain, D, Gordon, A, Lane, I, Hobbs, S, Pillay, W, Rowlands, T, El-Tahir, A, Asquith, J, Cavanagh, S, Dubois, L, Forbes, TL, Ashworth, E, Baker, S, Barakat, H, Brady, C, Brown, J, Bufton, C, Chance, T, Chrisopoulou, A, Cockell, M, Croucher, A, Dabee, L, Dewhirst, N, Evans, J, Gibson, A, Gorst, S, Gough, M, Graves, L, Griffin, M, Hatfield, J, Hogg, F, Howard, S, Hughes, C, Metcalfe, D, Lapworth, M, Massey, I, Novick, T, Owen, G, Parr, N, Pintar, D, Spencer, S, Thomson, C, Thunder, O, Wallace, T, Ward, S, Wealleans, V, Wilson, L, Woods, J & Zheng, T 2015, 'Endovascular strategy or open repair for ruptured abdominal aortic aneurysm: One-year outcomes from the IMPROVE randomized trial', European Heart Journal, vol. 36, no. 31, pp. 2061-2069. https://doi.org/10.1093/eurheartj/ehv125

TY - JOUR

T1 - Endovascular strategy or open repair for ruptured abdominal aortic aneurysm

T2 - One-year outcomes from the IMPROVE randomized trial

AU - Braithwaite, Bruce

AU - Greenhalgh, Roger M.

AU - Grieve, Richard

AU - Hassan, Tajek B.

AU - Moore, Fionna

AU - Nicholson, Anthony A.

AU - Soong, Chee V.

AU - Heatley, Francine

AU - Anjum, Aisha

AU - Kalinowska, Gosia

AU - Gomes, Manuel

AU - Powell, Janet T.

AU - Hinchliffe, Robert

AU - Sweeting, Michael

AU - Thompson, Matt M.

AU - Thompson, Simon G.

AU - Ulug, Pinar

AU - Roberts, Ian

AU - Bell, Peter R.F.

AU - Cheetham, Anne

AU - Stephany, Jenny

AU - Halliday, Alison W.

AU - Warlow, Charles

AU - Lamont, Peter

AU - Moss, Jonathan

AU - Tijssen, Jan

AU - Ashleigh, Ray

AU - Thompson, Matthew

AU - Thompson, Luke

AU - Cheshire, Nicholas J.

AU - Boyle, Jonathan R.

AU - Serracino-Inglott, Ferdinand

AU - Hinchliffe, Robert J.

AU - Bell, Rachel

AU - Wilson, Noel

AU - Bown, Matt

AU - Dennis, Martin

AU - Davis, Meryl

AU - Howell, Simon

AU - Wyatt, Michael G.

AU - Valenti, Domenico

AU - Bachoo, Paul

AU - Walker, Paul

AU - MacSweeney, Shane

AU - Davies, Jonathan N.

AU - Rittoo, Dynesh

AU - Parvin, Simon D.

AU - Yusuf, Waquar

AU - Nice, Colin

AU - Chetter, Ian

AU - Howard, Adam

AU - Chong, Patrick

AU - Bhat, Raj

AU - McLain, David

AU - Gordon, Andrew

AU - Lane, Ian

AU - Hobbs, Simon

AU - Pillay, Woolagasen

AU - Rowlands, Timothy

AU - El-Tahir, Amin

AU - Asquith, John

AU - Cavanagh, Steve

AU - Dubois, Luc

AU - Forbes, Thomas L.

AU - Ashworth, Emily

AU - Baker, Sara

AU - Barakat, Hashem

AU - Brady, Claire

AU - Brown, Joanne

AU - Bufton, Christine

AU - Chance, Tina

AU - Chrisopoulou, Angela

AU - Cockell, Marie

AU - Croucher, Andrea

AU - Dabee, Leela

AU - Dewhirst, Nikki

AU - Evans, Jo

AU - Gibson, Andy

AU - Gorst, Siobhan

AU - Gough, Moira

AU - Graves, Lynne

AU - Griffin, Michelle

AU - Hatfield, Josie

AU - Hogg, Florence

AU - Howard, Susannah

AU - Hughes, Cián

AU - Metcalfe, David

AU - Lapworth, Michelle

AU - Massey, Ian

AU - Novick, Teresa

AU - Owen, Gareth

AU - Parr, Noala

AU - Pintar, David

AU - Spencer, Sarah

AU - Thomson, Claire

AU - Thunder, Orla

AU - Wallace, Tom

AU - Ward, Sue

AU - Wealleans, Vera

AU - Wilson, Lesley

AU - Woods, Janet

AU - Zheng, Ting

PY - 2015/8/14

Y1 - 2015/8/14

N2 - 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.

AB - 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.

KW - Aneurysm

KW - Aorta

KW - Cost-effectiveness

KW - Rupture

KW - Stent grafts

KW - Surgery

UR - http://www.scopus.com/inward/record.url?scp=84939481430&partnerID=8YFLogxK

U2 - 10.1093/eurheartj/ehv125

DO - 10.1093/eurheartj/ehv125

M3 - Article

AN - SCOPUS:84939481430

SN - 0195-668X

VL - 36

SP - 2061

EP - 2069

JO - European Heart Journal

JF - European Heart Journal

IS - 31

ER -

Endovascular strategy or open repair for ruptured abdominal aortic aneurysm: One-year outcomes from the IMPROVE randomized trial

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