Abstract 13242: Tweedledum and Tweedledee? A Meta-analysis of Randomized and Adjusted Observational Studies of Endovascular versus Open Repair of Ruptured Abdominal Aortic Aneurysm
Background: Few randomized controlled trials (RCTs) suggest that endovascular aneurysm repair (EVAR) may not reduce mortality over open surgical repair (OSR) in patients with ruptured abdominal aortic aneurysm (RAAA). We performed a meta-analysis of EVAR versus OSR for reduction of mortality in RAAA.
Methods: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched through May 2013. Eligible studies were RCTs and adjusted observational comparative studies (OCSs) of EVAR versus OSR enrolling individuals with RAAA and reporting early (30-day or in-hospital) or late mortality as an outcome. Odds ratios (ORs) for early death and hazard ratios (HRs) for late death with 95% confidence intervals (CIs) (adjusted ORs and HRs in case of OCSs) were abstracted from each individual study.
Results: Only 2 RCTs and 20 adjusted OCSs enrolling a total of 50,696 patients with RAAA were identified and included. Pooled analysis of 21 studies (n = 50,622) suggested a significant reduction in early mortality among patients assigned to EVAR versus OSR (OR, 0.58; 95% CI, 0.51 to 0.66; P < 0.00001; Figure 1). Combining 16 OCSs using multivariate logistic regression (n = 42,080) generated an amplified and significant result favoring EVAR (OR, 0.52; 95% CI, 0.42 to 0.63; P < 0.00001; Figure 1). Pooled analysis of 7 studies (n = 4,799), however, indicated no significant difference in late (14-month to 8-year) mortality between EVAR and OSR (HR, 0.94; 95% CI, 0.77 to 1.14; P = 0.52; Figure 2).
Conclusion: EVAR appears to significantly reduce early mortality but not late mortality in selected patients with RAAA.
- © 2013 by American Heart Association, Inc.