Freemantle, N;
Ruel, M;
Gaudino, MFL;
Pagano, D;
(2018)
On the pooling and subgrouping of data from percutaneous coronary intervention versus coronary artery bypass grafting trials: a call to circumspection.
On the pooling and subgrouping of data from percutaneous coronary intervention versus coronary artery bypass grafting trials: a call to circumspection
, 53
(5)
pp. 915-918.
10.1093/ejcts/ezy140.
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Abstract
In the modern era, treatment choice is guided by scientific evidence, usually gathered from well-conducted clinical trials, and often followed by the pooling of their data. In this article, we review the most recent pooled evidence regarding myocardial revascularization strategies and discuss how these meta-analyses have inherent shortcomings that should be better understood, prior to their purported conclusions potentially influencing clinical decisions. Properly conducted randomized trials comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) can provide unbiased estimates of treatment effects. However, the design of such trials has often involved a primary outcome that is a composite measure and thus open to challenges with regard to the appropriate interpretation of each individual components. Quantitative synthesis of such data from multiple trials can enable estimates of individual components of the composite outcomes (e.g. all-cause mortality). Where individual patient data are available, a full investigation of mediating effects, or subgroups analyses, may also be undertaken. Relevant to this article, we now have multiple meta-analyses of trials available, which provide an opportunity to assess the appropriateness of criteria for patient selection between PCI and CABG. Consequently, we will appraise the robustness of these meta-analytic methods in answering the question at stake: does PCI provide equivalent results to CABG for the treatment of unprotected left main coronary artery stenosis and multivessel coronary artery disease?
| Type: | Article |
|---|---|
| Title: | On the pooling and subgrouping of data from percutaneous coronary intervention versus coronary artery bypass grafting trials: a call to circumspection |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1093/ejcts/ezy140 |
| Publisher version: | https://doi.org/10.1093/ejcts/ezy140 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | Percutaneous coronary intervention, Coronary artery bypass grafting, Individual patient meta-analysis, Network meta-analysis, Subgroups |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > Comprehensive CTU at UCL |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10052587 |
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