Comparative Effectiveness of Multivessel Coronary Artery Bypass Graft Surgery and Multivessel Percutaneous Coronary Intervention
Authors: Junji Kumasawa, Noriaki Kurita, Shunichi Fukuhara
Journal: Annals of Internal Medicine (2013)

LettersSeptember 17, 2013Comparative Effectiveness of Multivessel Coronary Artery Bypass Graft Surgery and Multivessel Percutaneous Coronary InterventionJunji Kumasawa, MD, Noriaki Kurita, MD, and Shunichi Fukuhara, MD, DMScJunji Kumasawa, MDFrom Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan., Noriaki Kurita, MDFrom Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan., and Shunichi Fukuhara, MD, DMScFrom Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-159-6-201309170-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Although we commend Hlatky and colleagues (1) for their attempts to assess the clinical characteristics that could modify the comparative effectiveness of coronary artery bypass graft (CABG) surgery versus percutaneous coronary intervention (PCI) in an unselected general population, the limitation of propensity score analysis when several unmeasured confounding factors are present should be emphasized. As the authors mentioned, medication and smoking status are critical confounding factors; however, there are several other unmeasured critical confounding factors, such as severe aortic calcification, immunosuppression, and systemic infection. McNulty and associates (2) explicitly identified that these factors contributed to the ineligibility ...References1. Hlatky MA, Boothroyd DB, Baker L, Kazi DS, Solomon MD, Chang TI, et al. Comparative effectiveness of multivessel coronary bypass surgery and multivessel percutaneous coronary intervention: a cohort study. Ann Intern Med. 2013;158:727-34 LinkGoogle Scholar2. McNulty EJ, Ng W, Spertus JA, Zaroff JG, Yeh RW, Ren XM, et al. Surgical candidacy and selection biases in nonemergent left main stenting: implications for observational studies. JACC Cardiovasc Interv. 2011;4:1020-7. [PMID: 21939943] CrossrefMedlineGoogle Scholar3. Stukel TA, Fisher ES, Wennberg DE, Alter DA, Gottlieb DJ, and Vermeulen MJ. Analysis of observational studies in the presence of treatment selection bias: effects of invasive cardiac management on AMI survival using propensity score and instrumental variable methods. JAMA. 2007;297:278-85. [PMID: 17227979] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoComparative Effectiveness of Multivessel Coronary Bypass Surgery and Multivessel Percutaneous Coronary Intervention Mark A. Hlatky , Derek B. Boothroyd , Laurence Baker , Dhruv S. Kazi , Matthew D. Solomon , Tara I. Chang , David Shilane , and Alan S. Go Comparative Effectiveness of Multivessel Coronary Artery Bypass Graft Surgery and Multivessel Percutaneous Coronary Intervention Mark A. Hlatky and Derek B. Boothroyd Metrics September 17, 2013Volume 159, Issue 6Page: 435KeywordsCatheterizationCoronary arteriesDeath ratesFactor analysisHeart rateInstrumental variable analysisMyocardial infarctionObservational studiesPercutaneous coronary interventionStable coronary artery diseaseSurgerySurvival analysis ePublished: 17 September 2013 Issue Published: September 17, 2013 CopyrightCopyright © 2013 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...