Evaluation of national institute for health and care excellence guidance for ruptured abdominal aortic aneurysms by emulating a hypothetical target trial

Frontiers in Cardiovascular Medicine

Cardiovascular Medicine

Florian Wolf¹  Christoph M. Domenig²  Wolf Eilenberg²  Christoph Neumayer²  Sebastian Lakowitsch²  Anna Sotir²  Christine Brostjan²  Henry Davies³  Mohammed A. Waduud³  D. Julian A. Scott³  Marc A. Bailey³  Georg Heinze⁴  Alexandra Kaider⁴ 

[1] Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria;Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria;Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom;Leeds Vascular Institute, Leeds General Infirmary, Leeds, United Kingdom;Section for Clinical Biometrics, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria;

关键词: aortic aneurysm;    infrarenal;    ruptured;    open repair;    endovascular aneurysm repair;    guidelines;   

DOI  :  10.3389/fcvm.2023.1219744

 received in 2023-05-09, accepted in 2023-07-17,  发布年份 2023

来源: Frontiers

【 摘 要 】

ObjectiveThis retrospective study evaluates the performance of UK National Institute for Health and Care Excellence (NICE) Guidelines on management of ruptured abdominal aortic aneurysms in a “real world setting” by emulating a hypothetical target trial with data from two European Aortic Centers.MethodsClinical data was retrospectively collected for all patients who had undergone ruptured endovascular aneurysm repair (rEVAR) and ruptured open surgical repair (rOSR). Survival analysis was performed comparing NICE compliance to usual care strategy. NICE compliers were defined as: female patients undergoing rEVAR; male patients >70 years old undergoing rEVAR; and male patients ≤70 years old undergoing rOSR. Hemodynamic instability was considered additionally.ResultsThis multicenter study included 298 patients treated for rAAA. The majority of patients were treated with rOSR (186 rOSR vs. 112 rEVAR). Overall, 184 deaths (68 [37%] with rEVAR and 116 [63%] with rOSR) were observed during the study period. Overall survival under usual care was 69.2% at 30 days, 56.5% at one year, and 42.4% at 5 years. NICE compliance gave survival outcomes of 73.1% at 30 days, 60.2% at 1 year and 42.9% at 5 years. The risk ratios at these time points, comparing NICE-compliance to usual care, were 0.88, 0.92 and 0.99, respectively.ConclusionsWe support NICE recommendations to manage men below the age of 71 years and hemodynamic stability with rOSR. There was a slight survival advantage for NICE compliers overall, in men >70 years and women of all ages.

【 授权许可】

Unknown   
© 2023 Eilenberg, Waduud, Davies, Bailey, Scott, Wolf, Sotir, Lakowitsch, Kaider, Heinze, Brostjan, Domenig and Neumayer.