Do higher-risk patients benefit from off-pump coronary artery bypass grafting? Evidence from an ecologic analysis of randomized trials Oliver Kuss, PhD,

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Presentation transcript:

Do higher-risk patients benefit from off-pump coronary artery bypass grafting? Evidence from an ecologic analysis of randomized trials Oliver Kuss, PhD, Jochen Börgermann, MD The Journal of Thoracic and Cardiovascular Surgery Volume 142, Issue 3, Pages e117-e122 (September 2011) DOI: 10.1016/j.jtcvs.2011.04.032 Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Scatter plots for each combination of risk factors (A, age; B, proportion female; C, ejection fraction) and outcome (mortality, myocardial infarction, stroke, and atrial fibrillation). Each plot gives 4 pieces of information. First, each circle represents a single study with its average value of the risk factor on the x-axis and the relative risk for off-pump surgery on the y-axis. Each circle area is proportional to the overall number of patients in the respective study. For plotting the circles (but not for statistical analysis), studies with no event in one or both treatment arms were corrected by the 0.5-continuity correction. Second, the black line gives the relative risk of the respective outcome with off-pump treatment depending on its value for the respective risk factor. These lines are allowed to vary across the range of the risk factor, indicating a potential effect modification of the off-pump effect. Third, light gray lines depict the off-pump effect (with its 95% confidence interval) as calculated from a model that assumes a constant treatment effect across the range of the risk factor. Fourth, the given P value stems from the test on the interaction of treatment and risk factor and can be interpreted as a test for no effect modification of the risk factor. MI, Myocardial infarction; AF, atrial fibrillation; LVEF, left ventricular ejection fraction. The Journal of Thoracic and Cardiovascular Surgery 2011 142, e117-e122DOI: (10.1016/j.jtcvs.2011.04.032) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Scatter plots for each combination of risk factors (A, age; B, proportion female; C, ejection fraction) and outcome (mortality, myocardial infarction, stroke, and atrial fibrillation). Each plot gives 4 pieces of information. First, each circle represents a single study with its average value of the risk factor on the x-axis and the relative risk for off-pump surgery on the y-axis. Each circle area is proportional to the overall number of patients in the respective study. For plotting the circles (but not for statistical analysis), studies with no event in one or both treatment arms were corrected by the 0.5-continuity correction. Second, the black line gives the relative risk of the respective outcome with off-pump treatment depending on its value for the respective risk factor. These lines are allowed to vary across the range of the risk factor, indicating a potential effect modification of the off-pump effect. Third, light gray lines depict the off-pump effect (with its 95% confidence interval) as calculated from a model that assumes a constant treatment effect across the range of the risk factor. Fourth, the given P value stems from the test on the interaction of treatment and risk factor and can be interpreted as a test for no effect modification of the risk factor. MI, Myocardial infarction; AF, atrial fibrillation; LVEF, left ventricular ejection fraction. The Journal of Thoracic and Cardiovascular Surgery 2011 142, e117-e122DOI: (10.1016/j.jtcvs.2011.04.032) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Scatter plots for each combination of risk factors (A, age; B, proportion female; C, ejection fraction) and outcome (mortality, myocardial infarction, stroke, and atrial fibrillation). Each plot gives 4 pieces of information. First, each circle represents a single study with its average value of the risk factor on the x-axis and the relative risk for off-pump surgery on the y-axis. Each circle area is proportional to the overall number of patients in the respective study. For plotting the circles (but not for statistical analysis), studies with no event in one or both treatment arms were corrected by the 0.5-continuity correction. Second, the black line gives the relative risk of the respective outcome with off-pump treatment depending on its value for the respective risk factor. These lines are allowed to vary across the range of the risk factor, indicating a potential effect modification of the off-pump effect. Third, light gray lines depict the off-pump effect (with its 95% confidence interval) as calculated from a model that assumes a constant treatment effect across the range of the risk factor. Fourth, the given P value stems from the test on the interaction of treatment and risk factor and can be interpreted as a test for no effect modification of the risk factor. MI, Myocardial infarction; AF, atrial fibrillation; LVEF, left ventricular ejection fraction. The Journal of Thoracic and Cardiovascular Surgery 2011 142, e117-e122DOI: (10.1016/j.jtcvs.2011.04.032) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Appendix Figure 1 Ecologic bias. The Journal of Thoracic and Cardiovascular Surgery 2011 142, e117-e122DOI: (10.1016/j.jtcvs.2011.04.032) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Appendix Figure 2 No ecologic bias. The Journal of Thoracic and Cardiovascular Surgery 2011 142, e117-e122DOI: (10.1016/j.jtcvs.2011.04.032) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Appendix Figure 3 No ecologic bias. The Journal of Thoracic and Cardiovascular Surgery 2011 142, e117-e122DOI: (10.1016/j.jtcvs.2011.04.032) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions