Document Detail


Smoking, lung function and the prognosis of abdominal aortic aneurysm. The UK Small Aneurysm Trial Participants.
MedLine Citation:
PMID:  10873733     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: the UK Small Aneurysm Trial was established to test the benefit of prophylactic elective surgery for small abdominal aortic aneurysms (4.0-5.5 cm in diameter) and identify prognostic risk factors, including smoking. PATIENTS, METHODS AND OUTCOMES: one thousand and ninety patients (902 men and 188 women, mean age 69.3 years) were randomised to either early elective surgery or ultrasonography surveillance until the aneurysm diameter exceeded 5. 5 cm, mean follow-up was 4.6 years. Baseline assessments included lung function tests and cotinine (a smoking marker). The principal outcome measures were all-cause mortality and aneurysm rupture. RESULTS: during the course of the trial, aneurysm rupture was diagnosed in 25 patients and 309 patients died. Whereas self-reported smoking status was not significantly associated with survival, patients without any trace of plasma cotinine had a significantly improved long-term (6-year) survival, p=0.02. Current smokers had a lower FEV(1)than past- and never-smokers. FEV(1)was the most powerful predictor of long-term (6-year) survival, the crude death rates per 100 person-years were 9.1, 6.9 and 4.6 for those with FEV(1)<1.9 l, 1.9-2.5 l and >2.5 l respectively, p=0.001. Moreover, the rupture rate was 1.9% per year for patients positive for plasma cotinine compared with 0.5% in those without trace of plasma cotinine, p=0.004. CONCLUSIONS: self-reported smoking status underestimates the effect of continued smoking on the prognosis of patients with small abdominal aortic aneurysm. Patients with high plasma cotinine concentrations (smokers) have an increased risk of aneurysm rupture and poorer long-term survival.
Authors:
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery     Volume:  19     ISSN:  1078-5884     ISO Abbreviation:  Eur J Vasc Endovasc Surg     Publication Date:  2000 Jun 
Date Detail:
Created Date:  2000-08-17     Completed Date:  2000-08-17     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9512728     Medline TA:  Eur J Vasc Endovasc Surg     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  636-42     Citation Subset:  IM    
Copyright Information:
Copyright 2000 Harcourt Publishers Ltd.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aneurysm, Ruptured / diagnosis*,  etiology,  mortality,  physiopathology
Aorta, Abdominal / ultrasonography
Aortic Aneurysm, Abdominal / diagnosis*,  etiology,  mortality,  physiopathology
Biological Markers / blood
Cotinine / blood
Female
Great Britain
Humans
Lung / physiopathology*
Male
Middle Aged
Prognosis
Respiratory Function Tests
Risk Factors
Smoking / adverse effects*,  blood
Surgical Procedures, Elective
Survival Rate
Vascular Surgical Procedures
Chemical
Reg. No./Substance:
0/Biological Markers; 486-56-6/Cotinine

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