Analysis with the propensity score of the association between likelihood of treatment and event of interest in observational studies. An example with myocardial reperfusion

Helena Martí, Jon Pérez-Bárcena, Miquel Fiol, Jaume Marrugat, Carmen Navarro, Elena Aldasoro, Adolfo Cabadés, Antonio Segura, Rafael Masiá, Javier Turumbay, Lluís Cirera, José M. Arteagoitia, Carlos A. Tomás, Gema Vega, Joan Sala, Enrique de los Arcos, María J. Tormo, Iraida Hurtado-de-Saracho, Mercedes Francés-Sempere, Roberto ElosuaEva Alonso, Fernando Arós, Covadonga Audicana, Mikel Basterretxea, Eduardo Castillo, Santiago Esnaola, Miguel A. García Calabuig, Miren Josebe Laresgoiti, Nerea Larrañaga, María José Lasa, Iñaki Lecuona, Nerea Muniozguren, María Cres Tobalina, Jesús M. San Vicente, Emilio Sanz, José Garía, Consuelo Martínez, Josefa Contreras, Fuensanta Aliaga, José M. Alonso, Manuel Belda, Rafael Bañón, José Antonio Castaño, Antonio Castilla, Juan Manuel Chiner, José M. Clemente, Amparo Egea, Francisco Felices, Manuel Fuentes, José Galcerá, Arcadio García, Francisco García, Pedro García, Gurmesindo González, Faustino Herrero, Pedro Jara, José Antonio Melgarejo, José Muñoz, Silvestre Nicolás, Juan Ortega, Miguel de Paco, Emilio Pérez, Pascual Rodríguez, Francisco Javier Rodríguez, Julio Ródenas, Francisco Ruiz-Martínez, José Antonio Ruiz, Fernando de San Eustaquio, Josefa Segura, José Antonio Serrano, Gines Torres, Luis Carlos Torres, Juan Vidal, Manuel Villegas, Amparo Albiñana, Carlos Antón, Joaquín Arguedas, Santiago Borrás, Susana Bosch, José P. Calabuig, Enrique Castellanos, Javier Cebrián, Francisco J. Domingo, Ildefonso Echánove, Enrique Ferrer, Mercedes Francés, Eva Gómez, Julián González, José Gregori, Javier Haba, Antonio López, Vicente López, Immaculada Melchor, Rafael Montero, Julio Montes, Ramón Navarro, Manuel Palanca, Miguel Palencia, Miguel Pérez

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Abstract

Introduction and objectives. Analysis of the effect of treatment in observational studies is complex due to differences between treated and nontreated patients. Calculating the probability of receiving treatment conditioned on relevant covariates (propensity score [PS]) has been proposed as a method to control for these differences. We report an application of PS to assess the association between reperfusion treatment and 28-day case fatality in patients with acute myocardial infarction (AMI). Method. We describe the procedure used to calculate PS for receiving reperfusion treatment, and different strategies to analyze the association between PS and case fatality with regression modeling and matching. Data were from a population-based registry of 6307 patients with AMI in Spain during 1997-98. Results. The PS for reperfusion was calculated in 5622 patients. In the multivariate analysis, reperfusion was associated with lower case fatality (OR= 0.59; 95% confidence interval [95% CI]: 0.46-077). When PS was included as a covariate, this association became non-significant (OR = 0.76; 95% CI: 0.57-1.01). In the subgroup of matched patients with a similar PS (n = 3138), treatment was not associated with case fatality (OR = 0.95; 95% CI: 0.72-1.26). When the influence of cases with missing data on PS was controlled for, reperfusion treatment was associated with lower fatality (OR = 0.66; 95% CI: 0.55-0.80). Conclusions. Calculating propensity score is a method that controls for differences between treated and nontreated patients. This score has limitations when matching is incomplete and when data are missing. Results of the present example suggest that reperfusion treatment reduces AMI case fatality.
Original languageEnglish
Pages (from-to)126-136
JournalRevista Espanola de Cardiologia
Volume58
Issue number2
Publication statusPublished - 1 Jan 2005

Keywords

  • Myocardial infarction
  • Prognosis
  • Reperfusion
  • Thrombolysis

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    Martí, H., Pérez-Bárcena, J., Fiol, M., Marrugat, J., Navarro, C., Aldasoro, E., Cabadés, A., Segura, A., Masiá, R., Turumbay, J., Cirera, L., Arteagoitia, J. M., Tomás, C. A., Vega, G., Sala, J., de los Arcos, E., Tormo, M. J., Hurtado-de-Saracho, I., Francés-Sempere, M., ... Pérez, M. (2005). Analysis with the propensity score of the association between likelihood of treatment and event of interest in observational studies. An example with myocardial reperfusion. Revista Espanola de Cardiologia, 58(2), 126-136.