Skip to main content

Comparing Inverse Probability of Treatment Weighting and Instrumental Variable Methods for the Evaluation of Adenosine Diphosphate Receptor Inhibitors After Percutaneous Coronary Intervention.

Publication ,  Journal Article
Federspiel, JJ; Anstrom, KJ; Xian, Y; McCoy, LA; Effron, MB; Faries, DE; Zettler, M; Mauri, L; Yeh, RW; Peterson, ED; Wang, TY ...
Published in: JAMA Cardiol
September 1, 2016

IMPORTANCE: There is increasing interest in performing comparative effectiveness analyses in large observational databases, yet these analyses must adjust for treatment selection issues. OBJECTIVES: To conduct comparative safety and efficacy analyses of prasugrel vs clopidogrel bisulfate after percutaneous coronary intervention and to evaluate inverse probability of treatment weighting (a propensity score method) and instrumental variable methods. DESIGN, SETTING, AND PARTICIPANTS: This study used data from the Treatment With Adenosine Diphosphate Receptor Inhibitors-Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (TRANSLATE-ACS) study. Included in the study were patients undergoing percutaneous coronary intervention for myocardial infarction, 26.0% of whom received prasugrel. The study dates were April 4, 2010, to October 31, 2012. EXPOSURES: Choice of initial antiplatelet agent (prasugrel or clopidogrel). MAIN OUTCOMES AND MEASURES: Safety and efficacy outcomes included 1-year composite major adverse cardiovascular events, moderate to severe bleeding, and stent thrombosis. Hospitalizations for pneumonia, bone fractures, and planned percutaneous coronary intervention were used as the falsification end points. RESULTS: The study cohort comprised 11 784 participants (mean [SD] age, 60.0 [11.6] years, and 28.0% were female). Using inverse probability of treatment weighting adjustment, prasugrel and clopidogrel had similar major adverse cardiovascular events (hazard ratio [HR], 0.98; 95% CI, 0.83-1.16) and bleeding outcomes (1.18; 0.77-1.80), but prasugrel had a lower rate of stent thrombosis (0.51; 0.31-0.85). Using instrumental variable methods, prasugrel use was associated with a lower rate of the major adverse cardiovascular event end point (HR, 0.68; 95% CI, 0.47-1.00) but nonsignificant differences in the rates of bleeding (0.95; 0.41-2.08) and stent thrombosis (0.67; 0.16-2.00). There was no significant treatment difference noted in any of the falsification end-point rates when analyses were performed using inverse probability of treatment weighting, although the bone fracture end point approached statistical significance. Nevertheless, a lower rate of pneumonia-related hospitalizations was noted in the prasugrel-treated patients when analyses were performed using instrumental variable methods. CONCLUSIONS AND RELEVANCE: Conclusions regarding the safety and efficacy of antiplatelet therapy varied depending on analytic technique, and none were concordant with the results from randomized trials. In addition, both statistical strategies demonstrated concerning associations when tested in the falsification analyses. A high level of scrutiny and careful attention to assumptions and validity are required when interpreting complex analyses of observational data.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

JAMA Cardiol

DOI

EISSN

2380-6591

Publication Date

September 1, 2016

Volume

1

Issue

6

Start / End Page

655 / 665

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Ticlopidine
  • Prasugrel Hydrochloride
  • Platelet Aggregation Inhibitors
  • Percutaneous Coronary Intervention
  • Middle Aged
  • Male
  • Humans
  • Female
  • Clopidogrel
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Federspiel, J. J., Anstrom, K. J., Xian, Y., McCoy, L. A., Effron, M. B., Faries, D. E., … Treatment With Adenosine Diphosphate Receptor Inhibitors–Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (TRANSLATE-ACS) Investigators, . (2016). Comparing Inverse Probability of Treatment Weighting and Instrumental Variable Methods for the Evaluation of Adenosine Diphosphate Receptor Inhibitors After Percutaneous Coronary Intervention. JAMA Cardiol, 1(6), 655–665. https://doi.org/10.1001/jamacardio.2016.1783
Federspiel, Jerome J., Kevin J. Anstrom, Ying Xian, Lisa A. McCoy, Mark B. Effron, Douglas E. Faries, Marjorie Zettler, et al. “Comparing Inverse Probability of Treatment Weighting and Instrumental Variable Methods for the Evaluation of Adenosine Diphosphate Receptor Inhibitors After Percutaneous Coronary Intervention.JAMA Cardiol 1, no. 6 (September 1, 2016): 655–65. https://doi.org/10.1001/jamacardio.2016.1783.
Federspiel, Jerome J., et al. “Comparing Inverse Probability of Treatment Weighting and Instrumental Variable Methods for the Evaluation of Adenosine Diphosphate Receptor Inhibitors After Percutaneous Coronary Intervention.JAMA Cardiol, vol. 1, no. 6, Sept. 2016, pp. 655–65. Pubmed, doi:10.1001/jamacardio.2016.1783.
Federspiel JJ, Anstrom KJ, Xian Y, McCoy LA, Effron MB, Faries DE, Zettler M, Mauri L, Yeh RW, Peterson ED, Wang TY, Treatment With Adenosine Diphosphate Receptor Inhibitors–Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (TRANSLATE-ACS) Investigators. Comparing Inverse Probability of Treatment Weighting and Instrumental Variable Methods for the Evaluation of Adenosine Diphosphate Receptor Inhibitors After Percutaneous Coronary Intervention. JAMA Cardiol. 2016 Sep 1;1(6):655–665.

Published In

JAMA Cardiol

DOI

EISSN

2380-6591

Publication Date

September 1, 2016

Volume

1

Issue

6

Start / End Page

655 / 665

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Ticlopidine
  • Prasugrel Hydrochloride
  • Platelet Aggregation Inhibitors
  • Percutaneous Coronary Intervention
  • Middle Aged
  • Male
  • Humans
  • Female
  • Clopidogrel