School of Population and Public Health (Sobolev), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Kuramoto), Vancouver Coastal Health Research Institute, Vancouver, BC
School of Population and Public Health (Sobolev), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Kuramoto), Vancouver Coastal Health Research Institute, Vancouver, BC.
CMAJ Open. 2022 Dec 13;10(4):E1052-E1058. doi: 10.9778/cmajo.20210183. Print 2022 Oct-Dec.
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.
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.
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.
在临床试验中，冠状动脉旁路移植术（CABG）优于经皮冠状动脉介入治疗（PCI），但这种优势可能不适用于治疗方法决定治疗时间的人群。我们旨在描述一项基于人群的观察性研究的方法，以评估治疗时间的变化如何影响这两种冠状动脉血运重建方法的比较效果。
我们提出了一个因果中介分析框架，以比较选择 CABG 而非 PCI 的结果，如果选择这两种方法的患者等待相同的时间，他们是否会接受 PCI。我们将纳入 2001 年 1 月至 2016 年 12 月不列颠哥伦比亚省首次接受非紧急孤立性 CABG 或多血管或左主干冠状动脉疾病单次 PCI 的患者。我们将使用绝对风险差异作为选择 CABG 而非 PCI 的总效果的衡量标准，并将其分为治疗选择的直接效果和治疗特异性时间介导的效果。
了解治疗时间如何调节血运重建方法与结果之间的关系，将对治疗选择、资源分配和规划基准产生影响。关于在特定时间内进行 PCI 或 CABG 的益处和风险的发现，将指导多学科团队为个体患者确定适当的血运重建方法。
