NEJM Audio Summary - April 19, 2012

Excerpted Script

0'47"| "Comparative Effectiveness of Revascularization Strategies" by William  Weintraub, from Christiana Care Health System, Newark, Delaware
A large registry on percutaneous coronary intervention (PCI) and a large registry on coronary-artery bypass grafting (CABG) were linked to claims records, with data adjusted for propensity score, to compare clinical outcomes.  Among patients 65 years of age or older who had two-vessel or three-vessel coronary artery disease without acute myocardial infarction, 86,244 underwent CABG and 103,549 underwent PCI. The median follow-up period was 2.67 years. At 1 year, there was no significant difference in adjusted mortality between the groups (6.24% in the CABG group as compared with 6.55% in the PCI group). At 4 years, there was lower mortality with CABG than with PCI (16.4% vs. 20.8%). Similar results were noted in multiple subgroups and with the use of several different analytic methods. In this observational study, we found that, among older patients with multivessel coronary disease that did not require emergency treatment, there was a long-term survival advantage among patients who underwent CABG as compared with patients who underwent PCI.
2'21"|  Laura Mauri from Brigham and Women's Hospital, Boston, writes in the editorial that the validity of these findings rests largely on a determination of whether adequate control for confounding was possible.  As might be expected in a nonrandomized cohort, patients in the two treatment groups differed significantly with respect to age, sex, coexisting conditions, and urgency of treatment. Propensity scores (which were used to estimate the probability, on the basis of patient and hospital characteristics, that patients would be selected for CABG) were also quite divergent, indicating a strong selection bias. Even with the findings adjusted for propensity score, the authors state their conclusions cautiously, and they acknowledge the possibility of residual confounding.

内容については、六号通り診療所所長のブログの「心臓のバイパス手術とカテーテル治療の予後を比較する」をご参照ください。何故、一科学者でもあられる天皇陛下がCABGを選択されたかが理解できます。