Aneurysm growth, survival, and quality of life in untreated thoracic aortic aneurysm: the effective treatments for thoracic aortic aneurysms study

ETTAA Collaborative Group, Linda Sharples*, Priya Sastry, Carol Freeman, Colin Bicknell, Yi-Da Chiu, Srinivasa Rao Vallabhaneni, Andrew Cook, Joanne Gray, Andrew McCarthy, Peter McMeekin, Luke Vale, Stephen Large

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Aims: To observe, describe, and evaluate management and timing of intervention for patients with untreated thoracic aortic aneurysms.

Methods and results: Prospective study of UK National Health Service (NHS) patients aged >_18 years, with new/existing arch or descending thoracic aortic aneurysms of >_4 cm diameter, followed up until death, intervention,
withdrawal, or July 2019. Outcomes were aneurysm growth, survival, quality of life (using the EQ-5D-5L utility index), and hospital admissions. Between 2014 and 2018, 886 patients were recruited from 30 NHS vascular/cardiothoracic units. Maximum aneurysm diameter was in the descending aorta in 725 (82%) patients, growing at 0.2 cm (0.17–0.24) per year. Aneurysms of >_4 cm in the arch increased by 0.07 cm (0.02–0.12) per year. Baseline diameter was related to age and comorbidities, and no clinical correlates of growth were found. During follow-up, 129 patients died, 64 from aneurysm-related events. Adjusting for age, sex, and New York Heart Association dyspnoea index, risk of death increased with aneurysm size at baseline [hazard ratio (HR): 1.88 (95% confidence interval: 1.64–2.16) per cm, P < 0.001] and with growth [HR: 2.02 (1.70–2.41) per cm, P < 0.001]. Hospital admissions increased with aneurysm size [relative risk: 1.21 (1.05–1.38) per cm, P = 0.008]. Quality of life decreased annually for each 10-year increase in age [–0.013 (–0.019 to –0.007), P < 0.001] and for current smoking [–0.043 (–0.064 to –0.023), P = 0.004]. Aneurysm size was not associated with change in quality of life.

Conclusion: International guidelines should consider increasing monitoring intervals to 12 months for small aneurysms and increasing intervention thresholds. Individualized decisions about surveillance/intervention should consider age, sex, size, growth, patient characteristics, and surgical risk.
Original languageEnglish
Pages (from-to)1-14
Number of pages14
JournalEuropean Heart Journal
Early online date29 Nov 2021
DOIs
Publication statusE-pub ahead of print - 29 Nov 2021

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