Key result
A proposed causal mediation analysis framework will evaluate how time to treatment mediates the comparative effectiveness of coronary artery bypass grafting versus percutaneous coronary intervention.
Why the study?
Trial-established advantages of CABG over PCI may not generalize when treatment method determines time to treatment, motivating methods to evaluate how timing affects comparative effectiveness.
Does time to treatment mediate the comparative effectiveness of CABG versus PCI in patients with multivessel or left main coronary artery disease?
Observational (n=38,000)
Does time to treatment mediate the comparative effectiveness of CABG versus PCI in patients with multivessel or left main coronary artery disease?
This methodology paper proposes a causal mediation analysis framework to determine if the longer wait times for CABG compared to PCI attenuate its relative benefits in patients with stable complex coronary artery disease.
Answers are grounded in this paper and cite their sources.
Should not yet alter CABG-PCI decisions; extends causal methods to evaluate time-to-treatment mediation in observational data.
BACKGROUND: The advantage of coronary artery bypass grafting (CABG) over percutaneous coronary intervention (PCI), established in trials, may not be generalizable to populations in which the method of treatment determines the time to treatment. We sought to describe the methodology of a population-based observational study for assessing how changes in time to treatment may affect the comparative effectiveness of these 2 methods of coronary revascularization. METHODS: We propose a framework of causal mediation analysis to compare the outcomes of choosing CABG over PCI, if patients selected for either method waited the same amount of time had they undergone a PCI. We will include patients who underwent a first-time, nonurgent isolated CABG or single-session PCI for multivessel or left main coronary artery disease from January 2001 to December 2016, in British Columbia. We will use absolute risk difference as a measure of the total effect of choosing CABG over PCI and partition it into the direct effect of the treatment choice and the effect mediated by the treatment-specific timing. INTERPRETATION: Understanding how time to treatment mediates the relation between method of revascularization and outcomes will have implications for treatment selection, resource allocation and planning benchmarks. Findings on the benefits and risks of performing PCI or CABG within a certain time will guide multidisciplinary teams in determining the appropriate revascularization method for individual patients.
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Sobolev et al. (2022) conducted an observational in Multivessel or left main coronary artery disease (n=38,000). Coronary artery bypass grafting (CABG) vs. Percutaneous coronary intervention (PCI) was evaluated on All-cause deaths, heart attack, stroke, heart failure and repeat revascularization. A proposed causal mediation analysis framework will evaluate how time to treatment mediates the comparative effectiveness of coronary artery bypass grafting versus percutaneous coronary intervention.
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