Propensity scores: an application in interventional cardiology

Trabalho de projecto de mestrado, Bioestatística, Universidade de Lisboa, Faculdade de Ciências, 2016 ; Invasive techniques are essential in investigation and management of cardiac and vascular diseases, particularly obstructive coronary artery disease. These invasive techniques can be performed for diagnostic or interventional purposes, and the access to the target arteries can be done through the femoral or the radial artery. The transradial approach may be clinically preferable, namely because its use has been associated with fewer peri-procedural complications, like bleeding. Despite the advantages over transfemoral approach, concerns have risen on the potential for transradial approach to increase the incidence of peri-procedural neurological complications, like Stroke or Transient Ischemic Attack (TIA) (Jurga et al., 2011). The aim of this work is to access the association between the risk of peri-procedural Stroke/TIA and the transradial or the transfemoral approaches. A propensity score analysis was performed in a sample of 16 710 patients included in a single prospective registry between January of 2006 and November of 2012. Various PS methods like matching, genetic matching, stratification and inverse probability of treatment weighting were used to estimate the Average Treatment Effect for the Treated (ATT) and the Average Treatment Effect (ATE). To find the best possible matching, PS estimates were fitted from a GAMs and from logistic regressions. A logistic regression (LR) was performed too in order to identify all the factors associated to the occurrence of peri-procedural Stroke/TIA and estimate the Odds Ratios. To handle the low number of events and the subsequent separation problem, a Firth’s logistic regression correction was run. Both Propensity Score analysis and regression methods reached the same conclusions. The use of Transradial or Transfemoral Approach does not impact the occurrence of peri-procedural Stroke/TIA. So the clinically preferential use of Transradial can be performed without ...