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

ETTAA Collaborative Group} and Linda Sharples and Priya Sastry a, , Sharples, Linda, Sastry, Priya, Freeman, Carol, Bicknell, Colin, Chiu, Yi-Da, Vallabhaneni, Srinivasa Rao, Cook, Andrew, Gray, Joanne, McCarthy, Andrew, McMeekin, Peter, Vale, Luke and Large, Stephen (2021) Aneurysm growth, survival, and quality of life in untreated thoracic aortic aneurysms: the effective treatments for thoracic aortic aneurysms study. European Heart Journal. pp. 1-14. ISSN 0195-668X (In Press)

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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.

Item Type: Article
Additional Information: Funding information: This work was supported by the National Institute for Health Research Health Technology Assessment, 11/147/03—Effective Treatments for Thoracic Aortic Aneurysms (ETTAA study): a prospective cohort study. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research, or the Department of Health.
Uncontrolled Keywords: Humans, Aortic aneurysm, Thoracic, Tomography, X-ray, Computed, Aorta and treatment outcome
Subjects: A300 Clinical Medicine
Department: Faculties > Health and Life Sciences > Nursing, Midwifery and Health
Depositing User: John Coen
Date Deposited: 01 Dec 2021 09:53
Last Modified: 28 Jun 2022 12:00

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