Does the outcome justify an oral-first treatment strategy for management of pulmonary arterial hypertension?
Cornwell WK, McLaughlin VV, Krishnan SM et al.
University of Michigan, Ann Arbor, MI, USA.
Chest 2011;140:697–705.
This is a retrospective, single-center analysis comparing outcomes in patients given first-line oral therapy with those treated with first-line intravenous/subcutaneous prostanoid therapy. There was no attempt to create comparable groups; therapy was based either on availability (1995–2002 only calcium channel blockers were available as an oral therapy) or clinician judgment, based on hemodynamic and clinical proxies for disease severity. While markers of adverse prognosis such as low 6-min walk distance (6MWD; <300 m), cardiac index <2 L/min/m2, right atrial pressure >12 mmHg, and mixed venous O2 saturation <55%) are mentioned, these were not used rigorously to determine treatment allocation. Unsurprisingly, therefore, first-line prostanoid therapy was associated with worse survival. When analyzed as separate groups, each outperformed their National Institutes of Health predicted survival curves.
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