Open AccessComparing Long-term Mortality After Carotid Endarterectomy vs Carotid Stenting Using a Novel Instrumental Variable Method for Risk Adjustment in Observational Time-to-Event Data
Author(s) -
Jesse A. Columbo,
Pablo MartínezCamblor,
Todd A. MacKenzie,
Douglas O. Staiger,
Ravinder Kang,
Philip P. Goodney,
A. James O’Malley
Publication year - 2018
Publication title -
jama network open
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.278
H-Index - 39
ISSN - 2574-3805
DOI - 10.1001/jamanetworkopen.2018.1676
Subject(s) - observational study , medicine , carotid endarterectomy , term (time) , carotid stenting , instrumental variable , event (particle physics) , cardiology , carotid arteries , statistics , mathematics , physics , quantum mechanics
Key Points Question Can a novel instrumental variable method designed for time-dependent outcomes more accurately determine the relative long-term mortality after carotid endarterectomy vs carotid artery stenting? Findings In this registry-based, multicenter cohort study of 86 017 patients, the hazard ratio of long-term mortality for carotid endarterectomy vs carotid artery stenting was 0.83 (95% CI, 0.70-0.98) using instrumental variable analysis, compared with 0.69 (95% CI, 0.65-0.74) using a traditional Cox regression model. Meaning Results from this instrumental variable method show that the survival advantage conferred by carotid endarterectomy is more modest than suggested by traditional adjustment methods, aligning with results from randomized clinical trials.
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