Thomas Dustin M, Hulten Edward A, Ellis Shane T, Anderson David M F, Anderson Nathan, McRae Fiora, Malik Jamil A, Villines Todd C, Slim Ahmad M
Cardiology Service MCHE-MDC, Brooke Army Medical Center, 3551 Roger Brooke Drive, San Antonio, TX 78234-6200, USA.
Cardiology Service, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA.
ISRN Cardiol. 2014 Apr 2;2014:149243. doi: 10.1155/2014/149243. eCollection 2014.
Background. We evaluated the incidence of mortality and myocardial infarction (MI) in endovascular repair (EVAR) as compared to open aneurysm repair (OAR) in both elective and ruptured abdominal aortic aneurysm (AAA ) setting. Methods. We analyzed the rates of 30-day mortality, 30-day MI, and hospital length of stay (LOS) based on comparative observation and randomized control trials involving EVAR and OAR. Results. 41 trials compared EVAR to OAR with a total pooled population of 37,781 patients. Analysis of elective and ruptured AAA repair favored EVAR with respect to 30-day mortality with a pooled odds ratio of 0.19 (95% CI 0.17-0.20; I (2) = 88.9%; P < 0.001). There were a total of 1,835 30-day MI events reported in the EVAR group as compared to 2,483 events in the OAR group. The pooled odds ratio for elective AAA was 0.74 (95% CI 0.58-0.96; P = 0.02) in favor of EVAR. The average LOS was reduced by 296.75 hrs (95% CI 156.68-436.82 hrs; P < 0.001) in the EVAR population. Conclusions. EVAR has lower rates of 30-day mortality, 30-day MI, and LOS in both elective and ruptured AAA repair.
背景。我们评估了在择期和破裂性腹主动脉瘤（AAA）情况下，血管腔内修复术（EVAR）与开放性动脉瘤修复术（OAR）相比的死亡率和心肌梗死（MI）发生率。方法。我们基于涉及EVAR和OAR的对比观察和随机对照试验，分析了30天死亡率、30天MI以及住院时间（LOS）。结果。41项试验将EVAR与OAR进行了比较，总共有37,781名患者纳入汇总分析。对择期和破裂性AAA修复的分析表明，在30天死亡率方面，EVAR更具优势，汇总比值比为0.19（95%置信区间0.17 - 0.20；I² = 88.9%；P < 0.001）。EVAR组共报告了1,835例30天MI事件，而OAR组为2,483例。择期AAA的汇总比值比为0.74（95%置信区间0.58 - 0.96；P = 0.02），支持EVAR。EVAR组的平均住院时间缩短了296.75小时（95%置信区间156.68 - 436.82小时；P < 0.001）。结论。在择期和破裂性AAA修复中，EVAR的30天死亡率、30天MI发生率和住院时间均较低。
