Evidence mapPaperPMID 41360633Full record

ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2025

Time-varying comparative effectiveness of surgical or percutaneous revascularization on patient-centred outcomes.

Vikram Fielding-Singh, Christian O'Donnell, Jack H Boyd, Meltem Tuna, Mamas A Mamas, Marc Ruel, Louise Y Sun

Abstract readComparative Study
In one paragraph

Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Vikram Fielding-SinghDivision of Cardiothoracic Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine (Fielding-Singh, O'Donnell, Sun); Stanford Cardiovascular Institute (Fielding-Singh, Boyd, Sun); Department of Medicine (O'Donnell); and Department of Cardiothoracic Surgery (Boyd), Stanford University School of Medicine, Stanford, Calif.; ICES uOttawa (Tuna, Sun); Ottawa Hospital Research Institute (Tuna), Ottawa, Ont.; Keele Cardiovascular Research Group (Mamas), Centre for Prognosis Research, Keele University, Staffordshire, UK; Division of Cardiac Surgery (Ruel), University of Ottawa Heart Institute, Ottawa, Ont.
Christian O'DonnellDivision of Cardiothoracic Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine (Fielding-Singh, O'Donnell, Sun); Stanford Cardiovascular Institute (Fielding-Singh, Boyd, Sun); Department of Medicine (O'Donnell); and Department of Cardiothoracic Surgery (Boyd), Stanford University School of Medicine, Stanford, Calif.; ICES uOttawa (Tuna, Sun); Ottawa Hospital Research Institute (Tuna), Ottawa, Ont.; Keele Cardiovascular Research Group (Mamas), Centre for Prognosis Research, Keele University, Staffordshire, UK; Division of Cardiac Surgery (Ruel), University of Ottawa Heart Institute, Ottawa, Ont.
Jack H BoydDivision of Cardiothoracic Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine (Fielding-Singh, O'Donnell, Sun); Stanford Cardiovascular Institute (Fielding-Singh, Boyd, Sun); Department of Medicine (O'Donnell); and Department of Cardiothoracic Surgery (Boyd), Stanford University School of Medicine, Stanford, Calif.; ICES uOttawa (Tuna, Sun); Ottawa Hospital Research Institute (Tuna), Ottawa, Ont.; Keele Cardiovascular Research Group (Mamas), Centre for Prognosis Research, Keele University, Staffordshire, UK; Division of Cardiac Surgery (Ruel), University of Ottawa Heart Institute, Ottawa, Ont.
Meltem TunaDivision of Cardiothoracic Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine (Fielding-Singh, O'Donnell, Sun); Stanford Cardiovascular Institute (Fielding-Singh, Boyd, Sun); Department of Medicine (O'Donnell); and Department of Cardiothoracic Surgery (Boyd), Stanford University School of Medicine, Stanford, Calif.; ICES uOttawa (Tuna, Sun); Ottawa Hospital Research Institute (Tuna), Ottawa, Ont.; Keele Cardiovascular Research Group (Mamas), Centre for Prognosis Research, Keele University, Staffordshire, UK; Division of Cardiac Surgery (Ruel), University of Ottawa Heart Institute, Ottawa, Ont.
Mamas A MamasDivision of Cardiothoracic Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine (Fielding-Singh, O'Donnell, Sun); Stanford Cardiovascular Institute (Fielding-Singh, Boyd, Sun); Department of Medicine (O'Donnell); and Department of Cardiothoracic Surgery (Boyd), Stanford University School of Medicine, Stanford, Calif.; ICES uOttawa (Tuna, Sun); Ottawa Hospital Research Institute (Tuna), Ottawa, Ont.; Keele Cardiovascular Research Group (Mamas), Centre for Prognosis Research, Keele University, Staffordshire, UK; Division of Cardiac Surgery (Ruel), University of Ottawa Heart Institute, Ottawa, Ont.
Marc RuelDivision of Cardiothoracic Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine (Fielding-Singh, O'Donnell, Sun); Stanford Cardiovascular Institute (Fielding-Singh, Boyd, Sun); Department of Medicine (O'Donnell); and Department of Cardiothoracic Surgery (Boyd), Stanford University School of Medicine, Stanford, Calif.; ICES uOttawa (Tuna, Sun); Ottawa Hospital Research Institute (Tuna), Ottawa, Ont.; Keele Cardiovascular Research Group (Mamas), Centre for Prognosis Research, Keele University, Staffordshire, UK; Division of Cardiac Surgery (Ruel), University of Ottawa Heart Institute, Ottawa, Ont.
Louise Y SunDivision of Cardiothoracic Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine (Fielding-Singh, O'Donnell, Sun); Stanford Cardiovascular Institute (Fielding-Singh, Boyd, Sun); Department of Medicine (O'Donnell); and Department of Cardiothoracic Surgery (Boyd), Stanford University School of Medicine, Stanford, Calif.; ICES uOttawa (Tuna, Sun); Ottawa Hospital Research Institute (Tuna), Ottawa, Ont.; Keele Cardiovascular Research Group (Mamas), Centre for Prognosis Research, Keele University, Staffordshire, UK; Division of Cardiac Surgery (Ruel), University of Ottawa Heart Institute, Ottawa, Ont. sunl@stanford.edu.

Funding

Toward optimizing dialysis in the perioperative periodK23DK138312 · STANFORD UNIVERSITY · 2025 to 2025
$166k
American Heart Association-American Stroke Association 23CDA1053913NIDDK NIH HHS K23 DK138312
6 · The paper itself

Abstract

backgroundLittle is known about the comparative risks and timing of patient-defined adverse cardiovascular and noncardiovascular events (PACE) after coronary artery revascularization. We investigated comparative risks of PACEs after coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI).

methodsWe conducted a retrospective cohort study of patients who underwent isolated index myocardial revascularization procedures between Oct. 1, 2008, and Dec. 31, 2018, in Ontario, Canada. The primary exposure was revascularization by CABG or PCI. The primary outcome was PACE, a composite of postoperative severe stroke, ventilator dependence, new-onset or worsening heart failure, long-term care admission, and new-onset dialysis. We modelled the association of revascularization strategy and PACE using an overlap-weighted, cause-specific hazard model, with death as a competing risk.

resultsOf 140 519 patients included in the analysis, 54 018 (38.4%) underwent CABG and 86 501 (61.6%) underwent PCI. The groups were well balanced after overlap weighting. During a median follow-up duration of 4.8 (interquartile range 2.5 to 7.6) years, a total of 22 926 (16.3%) patients experienced PACE, including 9725 (18.0%) in the CABG group and 13 201 (15.3%) in the PCI group. We found no significant between-group difference in the cumulative incidence of PACE over the entire study period (average hazard ratio [HR] 0.97, 95% confidence interval 0.94 to 1.01). However, the HR for PACE varied over time. The HR comparing CABG to PCI was elevated in the first year, reached a minimum of around 0.7 at years 3 and 4, and then rose, favouring PCI again after year 8.

interpretationThe comparative risk of PACE after CABG versus PCI varied significantly over time. These findings provide granular data to support physicians and patients engaged in shared decision-making about revascularization strategies.

Indexed as

Coronary Artery BypassCoronary Artery DiseasePercutaneous Coronary InterventionPostoperative ComplicationsAgedFemaleHumansMaleMiddle AgedOntarioRetrospective StudiesStrokeTime FactorsTreatment Outcome

Identifiers

PMID41360633
PMCPMC12685096

What Socratic holds

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LicenceCC BY-NC-ND
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.