Author + information
- Kimberly M. Brayton, MD, JD∗ (, )
- Vishal G. Patel, MD,
- Christopher Stave, MLS,
- James A. De Lemos, MD and
- Dharam J. Kumbhani, MD, SM
- ↵∗Center for Primary Care and Outcomes Research, Stanford School of Medicine, 117 Encina Commons, Room 116, Stanford, California 94305-6019
In their letter, although Dr. Bertrand and colleagues raise a number of points, their key concern appears to relate to the publication of 2 similar papers a few months apart. Our group was completely unaware of the meta-analysis by Abdelaal et al. (1) until our paper was already in revision at JACC, at which point we added a brief discussion of their paper to our revised paper (2). We fully acknowledge that the 2 papers are similar in content and conclusions and find it reassuring that 2 different groups working entirely independently, and with some differences in methodology, reached very similar conclusions. We believe that replication and validation remain essential steps in the scientific process, particularly for studies such as these that have direct clinical implications.
To specifically address the first of the numbered critiques in their letter, the paper by Chung et al. (3) clearly states in its Methods section that: “Patients who had fulfilled the enrollment criteria were randomly allocated to one of two groups: group A (same-day discharge) and group B (routine admission for close observation).” We acknowledge that the presentation of study results in the Chung et al. (3) paper is contradictory to this statement, however.
With regard to the issue of which observational studies were included in the 2 meta-analyses (point 3), our approach to the observational studies was markedly different from that of Abdelaal et al. (1) which led to different criteria for study selection. Because of our concerns about the validity of comparisons of nonrandomized study groups, we did not report any comparisons of outcomes between same-day discharge and overnight observation in the observational studies, but rather used the observational studies only to report pooled “real-world” absolute event rates among those actually discharged on the day of the percutaneous coronary intervention. This strategy avoids the substantial methodological weakness of observational comparisons but does allow the observational data to be used to estimate aggregate event rates. We continue to maintain that this is a methodological strength of our paper relative to that of Abdelaal et al. (1)
Finally, we agree with Dr. Bertrand and colleagues that it would be an overstatement to say, on the basis of either of our studies, that same-day discharge is “as safe” as overnight observation. Rather, as we stated in our original conclusions, larger, randomized studies of same-day discharge are needed to definitively establish its safety compared with overnight observation. In the meantime, the aggregate data from both meta-analyses support consideration of the practice in carefully selected patients.
Please note: Dr. Brayton is supported by grant number HS000028 from the National Institutes of Health; the contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the Agency for Healthcare Research & Quality. Dr. De Lemos has received honoraria from AstraZeneca; and is a consultant for sanofi-aventis and Daiichi Sankyo. Dr. Kumbhani has received honoraria from the American College of Cardiology and Somahlution. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation
- Abdelaal E.,
- Rao S.V.,
- Gilchrist I.C.,
- et al.
- Brayton K.M.,
- Patel V.G.,
- Stave C.,
- de Lemos J.A.,
- Kumbhani D.J.