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.

中文翻译：

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未经治疗的胸主动脉瘤的动脉瘤生长、生存和生活质量：胸主动脉瘤研究的有效治疗方法


目的 观察、描述和评估未经治疗的胸主动脉瘤患者的治疗和干预时机。方法和结果 对年龄 ≥ 18 岁、新发/现有弓形或降胸主动脉瘤直径≥ 4 cm 的英国国民医疗服务 (NHS) 患者进行前瞻性研究，随访直至死亡、干预、退出或 2019 年 7 月。结果为动脉瘤生长、生存、生活质量（使用 EQ-5D-5L 实用指数）和入院情况。 2014 年至 2018 年间，从 30 个 NHS 血管/心胸病科招募了 886 名患者。 725 名 (82%) 患者的最大动脉瘤直径位于降主动脉，每年增长 0.2 厘米 (0.17–0.24)。弓形内≥4厘米的动脉瘤每年增加0.07厘米（0.02-0.12）。基线直径与年龄和合并症有关，并且没有发现生长的临床相关性。在随访期间，129 名患者死亡，其中 64 人死于动脉瘤相关事件。调整年龄、性别和纽约心脏协会呼吸困难指数后，死亡风险随着基线时动脉瘤大小的增加而增加[风险比 (HR)：1.88（95% 置信区间：1.64–2.16）/cm，P < 0.001]随着生长[HR：2.02 (1.70–2.41)/cm，P < 0.001]。入院率随动脉瘤大小的增加而增加[相对风险：1.21 (1.05–1.38)/cm，P = 0.008]。年龄每增加 10 年，生活质量就会逐年下降 [–0.013 (–0.019 至 –0.007)，P < 0.001]，目前吸烟 [–0.043 (–0.064 至 –0.023)，P = 0.004]。动脉瘤大小与生活质量的变化无关。结论 国际指南应考虑将小动脉瘤的监测间隔延长至 12 个月，并提高干预阈值。 关于监测/干预的个体化决策应考虑年龄、性别、体型、生长、患者特征和手术风险。