Author + information
- Olivier F. Bertrand, MD, PhD∗ (, )
- Eltigani Abdelaal, MD,
- Sunil V. Rao, MD,
- Ian C. Gilchrist, MD,
- Ivo Bernat, MD, PhD,
- Adhir R. Shroff, MD, MPH,
- Ronald P. Caputo, MD,
- Olivier Costerousse, PhD and
- Samir B. Pancholy, MD
- ↵∗Laval Hospital, Quebec Heart-Lung Institute, Faculty of Medicine, Laval University, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Cardiology, 2725, chemin Ste Foy, Quebec City, Quebec G1V 4G5, Canada
We read with great interest the paper by Brayton et al. (1). This paper is nearly identical to our recent publication in JACC: Cardiovascular Interventions (2). It is interesting that 2 similar papers using the same data would be published in the JACC family of journals just a few months apart. Although Brayton and colleagues briefly acknowledge our paper in their discussion section, there are several aspects of their paper and claims regarding our study that deserve comment.
1. Table 1 in the paper by Brayton et al. lists a study by Chung et al. (3) as a randomized trial. We ask that they carefully review this study again because it is clearly stated in the paper that it is a prospective, nonrandomized study. We included this study in our meta-analysis appropriately as an observational study (reference 15).
2. Brayton and colleagues claim that their study differs from ours partly because they included 1 randomized trial that we did not. It appears that they are referring to a study by Glaser et al. (4) that randomized 39 patients. We concede that this was an oversight on our part, but given that we examined data from >111,000 patients, its inclusion would not have affected our results.
3. They also claim that they included 23 observational studies that we did not. We rejected these from our analysis because none of these studies included a comparator group who stayed overnight after a percutaneous coronary intervention. Including these studies does not conform to “best practice” for meta-analyses as described by the MOOSE (Meta-analysis Of Observational Studies in Epidemiology) group (5). Moreover, Brayton et al. (1) only present the mean value of outcomes among patients discharged the same day. No tables, forest plots, or comparisons with overnight stay are presented. This, too, violates meta-analytic best practice and cannot be used to support the safety of same-day discharge.
4. We are concerned that Brayton and colleagues chose the cumulative incidence of “death, MI, and TLR” as primary outcomes in their meta-analysis as target lesion revascularization was not reported in many of the included studies. Most studies reported “repeat PCI or revascularization,” which appears more clinically and cost relevant.
5. Although Brayton et al. (1) come to similar conclusions as we did, we believe that they have overstated their findings. Our conclusions were appropriately cautious considering the large heterogeneity of data and definitions used. This latter point is not discussed by Brayton et al. (1) at all. We also repeated our analysis using Bayesian techniques (data not shown), and the available evidence is practically inconclusive given the wide credible confidence intervals around the point estimates for outcomes. In contrast, Brayton et al. (1) conclude that same-day discharge is “as safe” as overnight observation. Although we agree with this on clinical grounds in selected patients, it is a clear overstatement of the data on statistical grounds.
6. On their last page of discussion, they claim that their study has a “significant methodological difference from [our study], which included patients not discharged as a post hoc ‘control arm’.” It is not at all clear what this means because, by definition, all analyses of observational data are necessarily post hoc.
Please note: Dr. Bertrand is a research-scholar of the Quebec Foundation for Health Research. Dr. Abdelaal is supported by the Laval University Transradial Research and Education Fund. Dr. Rao has received honoraria as a consultant for Terumo Medical and The Medicines Company. Dr. Shroff has received honoraria from Cordis, Terumo Medical, and The Medicines Company. Dr. Caputo has received honoraria as a consultant for Boston Scientific, Medtronic, and Terumo. Dr. Pancholy has received speaker honoraria from The Medicines Company. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation
- Brayton K.M.,
- Patel V.G.,
- Stave C.,
- de Lemos J.A.,
- Kumbhani D.J.
- Abdelaal E.,
- Rao S.V.,
- Gilchrist I.C.,
- et al.