Instrumental Variable Analysis to Compare Effectiveness of Stents in the Extremely Elderly

Yeh, Robert W.; Vasaiwala, Samip; Forman, Daniel E.; Silbaugh, Treacy S.; Zelevinski, Katya; Lovett, Ann; Normand, Sharon‐Lise T.; Mauri, Laura

doi:10.1161/circoutcomes.113.000476

Cited by 14 publications

(14 citation statements)

References 25 publications

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“…In our study, in addition to using standard adjustment and propensity score methods, we also used instrumental variable methods to address unmeasured factors. IV analysis is an econometric method which is gaining popularity in observational outcomes research and can address confounding due to measured and unmeasured factors . Similar to randomization, an IV is related to treatment selection but not directly related to the outcome.…”

Section: Discussionmentioning

confidence: 99%

The prognostic significance of incomplete revascularization and untreated coronary anatomy following percutaneous coronary intervention: An analysis of 6,755 patients with multivessel disease

Iqbal

Smith

Lane

et al. 2017

Cathet Cardio Intervent

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Section: Discussionmentioning

confidence: 99%

The prognostic significance of incomplete revascularization and untreated coronary anatomy following percutaneous coronary intervention: An analysis of 6,755 patients with multivessel disease

Iqbal

Smith

Lane

et al. 2017

Cathet Cardio Intervent

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“…IV analysis is an econometric method which is gaining popularity in observational outcomes research and can address confounding due to measured and unmeasured factors. This method has been used in comparative outcomes studies for DES versus BMS[ 10 , 30 ]. Similar to randomization, an IV is related to treatment selection but not directly related to the outcome.…”

Section: Discussionmentioning

confidence: 99%

Mid-to-long term mortality following surgical versus percutaneous coronary revascularization stratified according to stent subtype: An analysis of 6,682 patients with multivessel disease

et al. 2018

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BackgroundStudies comparing coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) have largely been performed in the bare-metal stent (BMS) and first-generation drug eluting stent (F-DES) era. Second-generation DES (S-DES) have shown improved outcomes when compared to F-DES, but data comparing CABG with PCI using S-DES is limited. We compared mortality following CABG versus PCI for patients with multivessel disease and analyzed different stent types.MethodsA total of 6,682 patients underwent multivessel revascularization at Harefield Hospital, UK. We stratified CABG patients into single arterial graft (SAG) or multiple arterial grafts (MAG); and PCI patients into BMS, F-DES or S-DES groups. We analyzed all-cause mortality at 5 years.Results4,388 patients had CABG (n[SAG] = 3,358; n[MAG] = 1,030) and 2,294 patients had PCI (n[BMS] = 416; n[F-DES] = 752; n[S-DES] = 1,126). PCI had higher 5-year mortality with BMS (HR = 2.27, 95% CI:1.70–3.05, p<0.001); F-DES (HR = 1.52, 95% CI:1.14–2.01, p = 0.003); and S-DES (HR = 1.84, 95% CI:1.42–2.38, p<0.001). This was confirmed in inverse probability treatment weighted analyses. When adjusting for both measured and unmeasured factors using instrumental variable analyses, PCI had higher 5-year mortality with BMS (Δ = 15.5, 95% CI:3.6,27.5, p = 0.011) and FDES (Δ = 16.5, 95% CI:6.6,26.4, p<0.001), but had comparable mortality with CABG for PCI with SDES (Δ = 0.9, 95% CI: -9.6,7.9, p = 0.844), and when exclusively compared to CABG patients with SAG (Δ = 0.4, 95% CI: -8.0,8.7, p = 0.931) or MAG (Δ = 4.6, 95% CI: -0.4,9.6, p = 0.931).ConclusionsIn this real-world analysis, when adjusting for measured and unmeasured confounding, PCI with SDES had comparable 5-year mortality when compared to CABG. This warrants evaluation in adequately-powered randomized controlled trials.

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“…IV analysis is an econometric method which is gaining popularity in observational outcomes research and can address confounding due to measured and unmeasured factors. This method has been used in comparative outcomes studies for DES versus BMS [25,30]. Similar to randomization, an IV is related to treatment selection but not directly related to the outcome.…”

Section: Discussionmentioning

confidence: 99%

Long‐term outcomes following drug‐eluting stents versus bare metal stents for primary percutaneous coronary intervention: A real‐world analysis of 11,181 patients from the british columbia cardiac registry

Iqbal

Nadra

Ding

et al. 2016

Cathet Cardio Intervent

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Instrumental Variable Analysis to Compare Effectiveness of Stents in the Extremely Elderly

Cited by 14 publications

References 25 publications

The prognostic significance of incomplete revascularization and untreated coronary anatomy following percutaneous coronary intervention: An analysis of 6,755 patients with multivessel disease

The prognostic significance of incomplete revascularization and untreated coronary anatomy following percutaneous coronary intervention: An analysis of 6,755 patients with multivessel disease

Mid-to-long term mortality following surgical versus percutaneous coronary revascularization stratified according to stent subtype: An analysis of 6,682 patients with multivessel disease

Long‐term outcomes following drug‐eluting stents versus bare metal stents for primary percutaneous coronary intervention: A real‐world analysis of 11,181 patients from the british columbia cardiac registry

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