Letter by Secemsky et al Regarding Article, “Relationship Between Femoral Vascular Closure Devices and Short-Term Mortality From 271 845 Percutaneous Coronary Intervention Procedures Performed in the United Kingdom Between 2006 and 2011: A Propensity Score–Corrected Analysis From the British Cardiovascular Intervention Society”

As interventional cardiologists, we often decide at the end of a procedure whether to close the femoral arterial access site with a vascular closure device (VCD). We make this decision based on a multitude of factors, including the extent of calcification of the femoral artery, the location and quality of the arterial puncture site, and whether the patient requires continued arterial pressure monitoring because of a tenuous condition, or conversely, might benefit from earlier ambulation with a VCD to facilitate same day discharge.As clinical investigators, we have learned that the inability to capture the clinical nuances that govern treatment decisions create the preconditions for confounding of observational studies, particularly when these variables may themselves be associated with …