Response by Nallamothu to Letter Regarding Article, “Effects of Percutaneous Coronary Intervention on Death and Myocardial Infarction Stratified by Stable and Unstable Coronary Artery Disease: A Meta-Analysis of Randomized Controlled Trials”

In Response:

We thank Dr Boden for his interest in the meta-analysis on the effects of revascularization outcomes with percutaneous coronary intervention by Chacko et al.¹ As a leader in the field for several decades, we consider his points about this study highly relevant for the cardiovascular community. We have reviewed the response by the authors including their decision to exclude the VANQWISH trial (Veterans Affairs Non–Q-Wave Infarction Strategies in Hospital) from their primary report. We understand that reasonable researchers (eg, Dr Boden) will disagree. We were pleased to see that for the most part, the results from the study by Chacko et al remain unchanged with inclusion of VANQWISH. We also agree, however, with the authors’ response that uncertainty may suggest the need for further work in this space.

Finally, our decision to publish this meta-analysis without the final International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial being published was ultimately mine. We did discuss this issue internally with various opinions among the Associate Editors. I concluded in the end that the quality of data available from the late-breaking clinical trial presentation at the American Heart Association meeting and the importance of the topic justified moving ahead. As a condition of acceptance, we asked the authors to be willing to rerun their analyses if numbers shift substantially in the final published version of the ISCHEMIA trial. Of course, we understand that some are likely to disagree with this decision. Thankfully the results from the ISCHEMIA trial in the official article that was just published in late March matched exactly those that were presented last fall.

Footnotes