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Evidence-based medicine and medical informatics
Published in David M. Luesley, Mark D. Kilby, Obstetrics & Gynaecology, 2016
The analysis of RCTs is often a simple comparison of percentages. The difference in the event rate (outcome of interest) in the treatment group compared with that in the comparison group is: Control event rate (%) – experimental event rate (%) = absolute risk reduction or risk difference (%)
The effect of cholecystectomy on the risk of acute myocardial infarction in patients with gallbladder stones
Published in Postgraduate Medicine, 2021
Chien-Hua Chen, Cheng-Li Lin, Chia-Hung Kao
Many epidemiological studies have supported the close association between GBS and CVD, including stroke and ischemic heart disease [12,22,23]. To our knowledge, our study is the first epidemiological study to support the protective effect of cholecystectomy against the development of AMI although our former publications have supported the protective effect of cholecystectomy on the development of stroke [24]. Along with our former studies regarding the association of GBS with stroke, erectile dysfunction, and migraine, this study may portend that GBS is a predictor or an independent risk factor of systemic vascular atherosclerosis [25–27]. GBS clinically attracts more attention on the incidence of biliary complications, such as cholecystitis, cholangitis, and pancreatitis, even though GBS recently has been viewed as an indicator of CVD [11–13]. Therefore, cholecystectomy is only indicated for biliary complications although the threshold for cholecystectomy has diminished after the introduction of laparoscopic cholecystectomy [28]. The NNT (number needed to treat) of cholecystectomy for GBS to prevent one AMI per year was approximately 1000 (1/ARR) in our study since ARR (absolute risk reduction) = EER (experimental event rate) – CER (control event rate) = 3.28/1,000–2.26/1,000 = 1.02/1,000. However, the NNT would be 585 for the patients with comorbidity (Table 3). Therefore, it requires more studies to select the appropriate candidates before expanding the indications of cholecystectomy for the prevention of AMI.