| アブストラクト | BACKGROUND: Observational studies of the effect of beta-blockers on all-cause mortality after an acute myocardial infarction (AMI) have tended to overestimate the effectiveness of this treatment. OBJECTIVE: To compare the estimates of the effect of beta-blocker use on mortality post-AMI derived from a traditional adjusted regression model with those from a marginal structural model. METHODS: A population-based cohort spanning the period of 2002-2004 was formed from the United Kingdom General Practice Research Database (GPRD). The cohort included all subjects who survived 90 days after their first AMI, who were then followed for 9 months. beta-Blocker use and blood pressure were identified in both the 90-day period before and the 90-day period after the AMI. Rate ratios (RR) were estimated using pooled logistic regression. RESULTS: The cohort included 9939 participants who survived 90 days after their AMI, of whom 633 died during the 9-month follow-up. Over 23% were taking beta-blockers pre-AMI, compared with 71% post-AMI. Using the traditional adjusted regression analysis, the RR of death with post-AMI beta-blocker use was 0.54 (95% confidence interval (CI): 0.45-0.67), while using the inverse probability of treatment weighting (IPTW) model it was 0.72 (95%CI: 0.61-0.84). The IPTW estimate is compatible with the estimate derived from a meta-analysis of randomized controlled trials (RCTs) while the adjusted regression estimate exaggerates the effectiveness. CONCLUSIONS: Observational studies of the association of anti-hypertensive medications with all-cause mortality should consider adding a marginal structural model to their armamentarium of data analysis. |
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| ジャーナル名 | Pharmacoepidemiology and drug safety |
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| Pubmed追加日 | 2008/10/25 |
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| 投稿者 | Delaney, Joseph A C; Daskalopoulou, Stella S; Suissa, Samy |
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| 組織名 | Department of Biostatistics, Collaborative Health Studies Coordinating Center,;University of Washington, Seattle, WA 98115 USA. jacd@u.washington.edu |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/18949804/ |
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