Systematic review and meta-analysis of cardiovascular events after endovascular aneurysm repair vs open surgical repair
Objective: Randomized controlled trials (RCTs) have shown a reduction in short-term mortality with endovascular aneurysm repair (EVAR) compared with open surgical repair (OSR) but failed to demonstrate a long-term mortality advantage. Our study aims to determine whether this loss of mortality benefi...
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Elsevier
2025-01-01
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| Series: | JVS-Vascular Insights |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S294991272500025X |
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| author | Catherine Boudreau, MD Graham McClure, MD, MSc Julien D’Astous, MD Kamil Polok, MD, PhD Jakub Fronczek, MD, PhD Augustin Toma, MD Stephen Yang, MD, MSc Fadi Elias, MD, MSc Wojciech Szczeklik, MD, PhD Emmanuelle Duceppe, MD, PhD |
| author_facet | Catherine Boudreau, MD Graham McClure, MD, MSc Julien D’Astous, MD Kamil Polok, MD, PhD Jakub Fronczek, MD, PhD Augustin Toma, MD Stephen Yang, MD, MSc Fadi Elias, MD, MSc Wojciech Szczeklik, MD, PhD Emmanuelle Duceppe, MD, PhD |
| author_sort | Catherine Boudreau, MD |
| collection | DOAJ |
| description | Objective: Randomized controlled trials (RCTs) have shown a reduction in short-term mortality with endovascular aneurysm repair (EVAR) compared with open surgical repair (OSR) but failed to demonstrate a long-term mortality advantage. Our study aims to determine whether this loss of mortality benefit could be attributed to differences in cardiovascular events. Methods: We searched MEDLINE, PubMed, Embase, and Web of Science for RCTs comparing EVAR and OSR for abdominal aortic aneurysm treatment. Title and abstracts, full texts, and study quality were assessed by two independent reviewers. Risk of bias was assessed using the Cochrane Collaboration tool for RCTs. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using the random-effects method, and heterogeneity was assessed using the I2 statistics. Results: Our search identified 5204 manuscripts, of which 99 full texts were screened, and 40 manuscripts included. Nine individual RCTs met the eligibility criteria. Inter-rater agreement was excellent for final study inclusion (k = 0.88). Overall, the risk of bias was low. Patients treated with EVAR had a significantly lower short-term mortality (RR: 0.65, 95% CI: 0.43-0.99). The totality of evidence on cardiovascular mortality (3 studies; 1265 patients, RR: 0.61, 95% CI: 0.16-2.25) did not rule out large differences in mortality in either direction. There were no statistically significant differences in long-term all-cause mortality (6 studies; 3436 patients, RR: 1.00, 95% CI: 0.95-1.06) and cardiovascular mortality (4 studies; 3097 patients, RR 1.09, 95% CI: 0.92-1.30), although for the later, the point estimate shifted in the other direction. Conclusions: Postoperative cardiovascular complications are frequent after abdominal aortic aneurysm repair, and most events are asymptomatic. More data are needed to inform whether the loss of mortality benefit at long-term follow-up with EVAR compared with OSR could be explained by prognostically important undetected cardiac events. |
| format | Article |
| id | doaj-art-b92360dcee9f4da7bc5bc1f23220e23b |
| institution | DOAJ |
| issn | 2949-9127 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JVS-Vascular Insights |
| spelling | doaj-art-b92360dcee9f4da7bc5bc1f23220e23b2025-08-20T03:05:22ZengElsevierJVS-Vascular Insights2949-91272025-01-01310020810.1016/j.jvsvi.2025.100208Systematic review and meta-analysis of cardiovascular events after endovascular aneurysm repair vs open surgical repairCatherine Boudreau, MD0Graham McClure, MD, MSc1Julien D’Astous, MD2Kamil Polok, MD, PhD3Jakub Fronczek, MD, PhD4Augustin Toma, MD5Stephen Yang, MD, MSc6Fadi Elias, MD, MSc7Wojciech Szczeklik, MD, PhD8Emmanuelle Duceppe, MD, PhD9Division of Vascular Surgery, Department of Surgery, University of Montreal, Montreal, QC, CanadaDivision of Vascular Surgery, Department of Surgery, McMaster University, Hamilton, ON, CanadaDivision of Internal Medicine, Department of Medicine, University of Montreal, Montreal, QC, CanadaCentre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, PolandCentre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, PolandDepartment of Medicine, University of Toronto, Toronto, ON, CanadaDivision of Critical Care, Department of Anesthesia, McGill University, Montreal, QC, CanadaDivision of Vascular Surgery, Department of Surgery, McMaster University, Hamilton, ON, CanadaCentre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, PolandDivision of Internal Medicine, Department of Medicine, University of Montreal, Montreal, QC, Canada; Correspondence: Emmanuelle Duceppe, MD, PhD, Division of Internal Medicine, Department of Medicine, University of Montreal, 1000 rue Saint-Denis, Montreal, QC H2X 0C1, CanadaObjective: Randomized controlled trials (RCTs) have shown a reduction in short-term mortality with endovascular aneurysm repair (EVAR) compared with open surgical repair (OSR) but failed to demonstrate a long-term mortality advantage. Our study aims to determine whether this loss of mortality benefit could be attributed to differences in cardiovascular events. Methods: We searched MEDLINE, PubMed, Embase, and Web of Science for RCTs comparing EVAR and OSR for abdominal aortic aneurysm treatment. Title and abstracts, full texts, and study quality were assessed by two independent reviewers. Risk of bias was assessed using the Cochrane Collaboration tool for RCTs. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using the random-effects method, and heterogeneity was assessed using the I2 statistics. Results: Our search identified 5204 manuscripts, of which 99 full texts were screened, and 40 manuscripts included. Nine individual RCTs met the eligibility criteria. Inter-rater agreement was excellent for final study inclusion (k = 0.88). Overall, the risk of bias was low. Patients treated with EVAR had a significantly lower short-term mortality (RR: 0.65, 95% CI: 0.43-0.99). The totality of evidence on cardiovascular mortality (3 studies; 1265 patients, RR: 0.61, 95% CI: 0.16-2.25) did not rule out large differences in mortality in either direction. There were no statistically significant differences in long-term all-cause mortality (6 studies; 3436 patients, RR: 1.00, 95% CI: 0.95-1.06) and cardiovascular mortality (4 studies; 3097 patients, RR 1.09, 95% CI: 0.92-1.30), although for the later, the point estimate shifted in the other direction. Conclusions: Postoperative cardiovascular complications are frequent after abdominal aortic aneurysm repair, and most events are asymptomatic. More data are needed to inform whether the loss of mortality benefit at long-term follow-up with EVAR compared with OSR could be explained by prognostically important undetected cardiac events.http://www.sciencedirect.com/science/article/pii/S294991272500025XAortic aneurysmEndovascular procedurePostoperative complicationsMyocardial infarctionMortality |
| spellingShingle | Catherine Boudreau, MD Graham McClure, MD, MSc Julien D’Astous, MD Kamil Polok, MD, PhD Jakub Fronczek, MD, PhD Augustin Toma, MD Stephen Yang, MD, MSc Fadi Elias, MD, MSc Wojciech Szczeklik, MD, PhD Emmanuelle Duceppe, MD, PhD Systematic review and meta-analysis of cardiovascular events after endovascular aneurysm repair vs open surgical repair JVS-Vascular Insights Aortic aneurysm Endovascular procedure Postoperative complications Myocardial infarction Mortality |
| title | Systematic review and meta-analysis of cardiovascular events after endovascular aneurysm repair vs open surgical repair |
| title_full | Systematic review and meta-analysis of cardiovascular events after endovascular aneurysm repair vs open surgical repair |
| title_fullStr | Systematic review and meta-analysis of cardiovascular events after endovascular aneurysm repair vs open surgical repair |
| title_full_unstemmed | Systematic review and meta-analysis of cardiovascular events after endovascular aneurysm repair vs open surgical repair |
| title_short | Systematic review and meta-analysis of cardiovascular events after endovascular aneurysm repair vs open surgical repair |
| title_sort | systematic review and meta analysis of cardiovascular events after endovascular aneurysm repair vs open surgical repair |
| topic | Aortic aneurysm Endovascular procedure Postoperative complications Myocardial infarction Mortality |
| url | http://www.sciencedirect.com/science/article/pii/S294991272500025X |
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