Efficacy versus effectiveness of carotid endarterectomy.
作者： John D. Birkmeyer , David A. Gould
DOI:
关键词: Internal medicine 、 Number needed to treat 、 Cumulative incidence 、 Carotid endarterectomy 、 Stenosis 、 Endarterectomy 、 Cardiology 、 Medicine 、 Stroke 、 Population 、 Asymptomatic
摘要: Context Several well-known clinical trials have demonstrated that the value of carotid endarterectomy depends on preoperative symptoms and degree artery stenosis. The benefit surgery also how results these (defining efficacy endarterectomy) are applied to actual practice (the effectiveness procedure), where surgical risks greater. Count number endarterectomies needed prevent one major stroke or death--that is, treat (NNT). Calculation Reciprocal difference between 5-year cumulative incidence death with medical therapy endarterectomy. Data sources Efficacy was calculated data from North American Symptomatic Carotid Endarterectomy Trials Asymptomatic Atherosclerosis Study. In calculating effectiveness, we accounted for increased mortality rates reported in population-based studies. Results For symptomatic patients, NNT predicted by model differed little estimated (10 versus 9 severe stenosis 29 23 moderate stenosis). However, substantially higher than patients asymptomatic (63 38). Conclusions is both efficacious effective (to a lesser extent) benefits observed published may overestimate those likely be achieved practice.
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