What determines propensity score depends on what we are determining propensity for: Comment on a recent analysis of arterial access route in acute myocardial infarction

摘要

Valgimigli et al. presented a retrospective analysis of the risk of bleeding and vascular complications with a transradial approach versus transfemoral access in patients presenting with acute myo-cardial infarction and reported a significantly lower rate of adverse events with transradial intervention. While we believe strongly in the benefits of transradial access, we have some serious reservations regarding the way that propensity score matching was used in this study. In their analysis, the authors sought to derive 2 comparable groups of patients from a highly biased registry and propensity matching is a very good method to achieve this, particularly considering the high quality of clinical information contained in the registry. However, our concern regarding the analysis centers on their inclusion of angiographic data in the derivation of the propensity score. Details, such as culprit vessel, lesion length, and type of stent cannot possibly be known before the route of access is decided.