SynthesisCirculation. Cardiovascular quality and outcomes2019
Systematic Evaluation of the Robustness of the Evidence Supporting Current Guidelines on Myocardial Revascularization Using the Fragility Index.
Synthesis in Circulation. Cardiovascular quality and outcomes, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
16 citing papers in PubMed, 3 syntheses or guidelines pooled it, 31 citations in OpenAlex.
- The Statistical Fragility of Saline Nasal Irrigation for Rhinosinusitis: A Systematic Review.The Laryngoscope · 2026Pooled it
- Characteristics of Randomized Clinical Trials in Surgery From 2008 to 2020: A Systematic Review.JAMA network open · 2021Pooled it
- Pooled it
- How trustworthy and applicable is the evidence from systematic reviews of depression treatments: Protocol for systematic examination.PloS one · 2025Article
- Article
- Fragility in cardiovascular randomized controlled trials with primary continuous outcomes (2018-2022) from multi-perspectives assessment: a cross-sectional survey.Annals of medicine · 2024Article
- Article
- The Fragility Index of Randomized Controlled Trials for Preterm Neonates.Frontiers in pediatrics · 2022Article
- On clinical trial fragility due to patients lost to follow up.BMC medical research methodology · 2021Article
- Fragility Index and Fragility Quotient in Randomized Controlled Trials on Corticosteroids in ARDS Due to COVID-19 and Non-COVID-19 Etiology.Journal of clinical medicine · 2021Review
- The fragility index can be used for sample size calculations in clinical trials.Journal of clinical epidemiology · 2021Article
- Fragility of results from randomized controlled trials supporting the guidelines for the treatment of osteoporosis: a retrospective analysis.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2021Article
- Antithrombotic Therapy Recommendations in the European Society of Cardiology Guidelines: How Robust Are the Randomized Controlled Trials Underpinning Them?TH open : companion journal to thrombosis and haemostasis · 2021Article
- How fragile are Mediterranean diet interventions? A research-on-research study of randomised controlled trials.BMJ nutrition, prevention & health · 2021Article
- Survival-Inferred Fragility Index of Phase 3 Clinical Trials Evaluating Immune Checkpoint Inhibitors.JAMA network open · 2020Article
- Characteristics of Contemporary Randomized Clinical Trials and Their Association With the Trial Funding Source in Invasive Cardiovascular Interventions.JAMA internal medicine · 2020Review
Corrections and comments
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Authors and funding
14 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundRCTs (randomized controlled trials) are the preferred source of evidence to support professional societies' guidelines. The fragility index (FI), defined as the minimum number of patients whose status would need to switch from nonevent to event to render a statistically significant result nonsignificant, quantitatively estimates the robustness of RCT results. We evaluate RCTs supporting current guidelines on myocardial revascularization using the FI and FI minus number of patients lost to follow-up. METHODS AND
resultsThe FI and FI minus number of patients lost to follow-up of RCTs supporting the 2012 American College of Cardiology/American Heart Association Guideline for the Diagnosis and Management of Patients with Stable Ischemic Heart Disease, the 2014 Focused Update of the American College of Cardiology/American Heart Association Guideline for the Diagnosis and Management of Patients with Stable Ischemic Heart Disease, and the 2018 European Society of Cardiology/European Association for Cardio-Thoracic Surgery Guidelines for Myocardial Revascularization were calculated. Of 414 RCTs identified, 160 were eligible for FI calculation. The median FI was 8.0 (95% CI, 5.0-9.0) and the median FI minus number of patients lost to follow-up was 1.0 (95% CI, 0.0-3.0). FI was ≤3, indicating very limited robustness, in 44 (27.5%) RCTs, and was lower than the number LTF, indicating limited robustness, in 68 (42.5%) RCTs. FI was significantly (all
conclusionsMore than a quarter of RCTs that support current guidelines on myocardial revascularization have a FI of 3 or lower, and over 40% of trials reveal a FI that is lower than the number of patients lost to follow-up. These findings suggest that the robustness of the findings that support current myocardial revascularization guidelines is tenuous and vulnerable to change as new evidence from RCTs appears.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.