Systematic review and meta-analysis of cardiovascular events after endovascular aneurysm repair vs open surgical repair
Bibliographic record
Abstract
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 I 2 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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.025 | 0.072 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.029 | 0.033 |
| Bibliometrics | 0.010 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".