Imperial College London
Alternate

Dr Francine Heatley

Faculty of Medicine, Department of Surgery & Cancer

Clinical Trials Manager
 
 
 
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Contact

 

+44 (0)20 3311 7371f.heatley Website

 
 
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Location

 

3E4East WingCharing Cross Campus

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Summary

 

Publications

Citation

BibTex format

@article{Grieve:2015:eurheartj/ehv125,
author = {Grieve, R and Gomes, M and Sweeting, MJ and Ulug, P and Hinchliffe, RJ and Thompson, MM and Thompson, SG and Ashleigh, R and Greenhalgh, RM and Powell, JT and IMPROVE, trial investigators},
doi = {eurheartj/ehv125},
journal = {European Heart Journal},
pages = {2061--2069},
title = {Endovascular strategy or open repair for ruptured abdominal aortic aneurysm: one-year outcomes from the IMPROVE randomized trial},
url = {http://dx.doi.org/10.1093/eurheartj/ehv125},
volume = {36},
year = {2015}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
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. CLINICAL TRIAL REGISTRATION: ISRCTN 48334791.
AU  - Grieve,R
AU  - Gomes,M
AU  - Sweeting,MJ
AU  - Ulug,P
AU  - Hinchliffe,RJ
AU  - Thompson,MM
AU  - Thompson,SG
AU  - Ashleigh,R
AU  - Greenhalgh,RM
AU  - Powell,JT
AU  - IMPROVE,trial investigators
DO  - eurheartj/ehv125
EP  - 2069
PY  - 2015///
SN  - 1522-9645
SP  - 2061
TI  - Endovascular strategy or open repair for ruptured abdominal aortic aneurysm: one-year outcomes from the IMPROVE randomized trial
T2  - European Heart Journal
UR  - http://dx.doi.org/10.1093/eurheartj/ehv125
UR  - https://academic.oup.com/eurheartj/article/36/31/2061/2398075
UR  - http://hdl.handle.net/10044/1/24614
VL  - 36
ER  -
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