Author + information
- F.James Brennan, MD, FACCa ()
In a recent Journalarticle, Rodriguez et al. (1)reported that the rates of death and myocardial infarction during long-term follow-up were lower in patients undergoing percutaneous transluminal coronary revascularization (PTCR) than in patients undergoing coronary artery bypass graft (CABG) surgery. This conclusion requires careful scrutiny owing to possible under-reporting of major events.
The study was designed with a composite primary end point that included death, myocardial infarction, cerebrovascular accident and myocardial re-revascularization. Presumably, once a patient experienced a primary end point event, that patient would be withdrawn from further analysis. A patient who underwent a second revascularization procedure and subsequently died would not be reported as a death, for example. In the Rodriguez et al. study, patients randomized to PTCR were more likely to have a second revascularization procedure than were those assigned to CABG. Subsequent major events occuring in such patients would not be reported. This would bias the mortality and myocardial infarction rates in favor of PTCR.
- American College of Cardiology
- ERACI II Investigators,
- Rodriguez A.,
- Bernardi V.,
- Navia J.,
- et al.