This review is a helpful entry point into TT thinking, but it may overstate the extent to which TTE can support causal inference when applied to retrospective data. TTE can help avoid preventable design errors, including self-inflicted biases. It does not recreate randomization, blinding or prospective capture of the factors that drive both tx choice and outcome. For that reason, many CV TTE studies should be described more cautiously: as structured observational comparisons, or at best hypothesis-generating, unless the data source was prospectively designed, audited, and shown to contain the main determinants of tx choice and outcome. As
@f2harrell has argued, a more accurate label for many of these studies may be “Best Practices in Observational Comparisons” rather than TTE.