Center for Evidence Synthesis in Health, School of Public Health, Brown University, Providence, Rhode Island.
Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island.
Am J Epidemiol. 2018 May 1;187(5):1064-1078. doi: 10.1093/aje/kwx214.
This review examines the conduct and reporting of observational studies using propensity score-based methods to compare coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or medical therapy for patients with coronary artery disease. A systematic selection process identified 48 studies: 20 addressing CABG versus PCI; 21 addressing bare-metal stents versus drug-eluting stents; 5 addressing CABG versus medical therapy; 1 addressing PCI versus medical therapy; and 1 addressing drug-eluting stents versus balloon angioplasty. Of 32 studies reporting information on variable selection, 7 relied exclusively on statistical criteria for the association of covariates with treatment, and 5 used such criteria to determine whether product or nonlinear terms should be included in the propensity score model. Twenty-five (52%) studies reported assessing covariate balance using the estimated propensity score, but only 1 described modifications to the propensity score model based on this assessment. The over 400 variables used in the 48 propensity score models were classified into 12 categories and 60 subcategories; only 17 subcategories were represented in at least half of the propensity score models. Overall, reporting of propensity score-based methods in observational studies comparing CABG, PCI, and medical therapy was incomplete; when adequately described, the methods used were often inconsistent with current methodological standards.
这篇综述检查了使用倾向评分匹配方法进行的观察性研究的实施和报告，以比较冠状动脉旁路移植术（CABG）、经皮冠状动脉介入治疗（PCI）或药物治疗在冠状动脉疾病患者中的应用。通过系统的选择过程，确定了 48 项研究：20 项研究比较 CABG 与 PCI；21 项研究比较裸金属支架与药物洗脱支架；5 项研究比较 CABG 与药物治疗；1 项研究比较 PCI 与药物治疗；1 项研究比较药物洗脱支架与球囊血管成形术。在报告变量选择信息的 32 项研究中，有 7 项完全依赖于协变量与治疗之间的关联的统计学标准，有 5 项研究使用这些标准来确定是否应在倾向评分模型中包含产品或非线性项。25 项（52%）研究报告使用估计的倾向评分评估协变量的平衡，但只有 1 项研究描述了基于此评估对倾向评分模型的修改。在这 48 个倾向评分模型中使用的 400 多个变量被分为 12 个类别和 60 个子类别；只有 17 个子类别至少出现在一半的倾向评分模型中。总的来说，比较 CABG、PCI 和药物治疗的观察性研究中倾向评分匹配方法的报告不完整；当充分描述时，所使用的方法往往与当前的方法学标准不一致。
