Efficacy of dual antiplatelet therapy for three months versus 12 months after coronary artery bypass grafting: multicentre, double blinded, randomised controlled trial.
Yuan X, Li J, Lei L, Zhang L, Chen K, Chu Q, Feng W, Wang X, Wang X, Xu F, Liu S, Yang Y, Wang X, Wang H, Dong A, Cheng Z, Guo H, Zhou T, Chen X, Ge J, Zhang L, Liu S, Shen Z, Wang J, Wang Y, Li W, Hu S, TOP-CABG Collaborative Group
- DOI
- 10.1136/bmj-2025-088939
- Record issued
- 2026-08-15
- Engine
- 7.39.0
- Exported
- 2026-09-21
Prepared by Alpha1. This document is confidential: it is intended for the recipient it was shared with and must not be redistributed. The live record at alpha1science.com/verify/6e04ae39-7385-4c68-9ffd-be11455b62b5 is authoritative.
How this rating was calculated
- StatisticsImpossible or misreported statistic−1★
- IntegrityIntegrity concern−0.5★
- ClaimsEfficacy rests on an unvalidated surrogate endpoint−0.5★
- ClaimsTreatment effect not shown to be clinically meaningful−0.5★
A demonstrable critical failure caps the rating at the minimum, regardless of the deductions above.
- No data or code availability links were detected to verify.
- 01Significance claim does not survive recomputationdemonstrable
Non-inferiority p-value for SVG occlusion
“Saphenous vein graft occlusion occurred in 280 of 2596 (10.8%) in the three month DAPT group and 283 of 2529 (11.2%) in the 12 month DAPT group (absolute difference −0.31%, 95% confidence interval (CI) −3.13% to 2.52%; P=0.008 for non-inferiority).”
- 02Efficacy rests on an unvalidated surrogate endpoint
The primary efficacy outcome is saphenous vein graft occlusion at one year, a surrogate for clinical outcomes. The paper does not provide evidence linking SVG occlusion to patient-important outcomes, nor does it demonstrate target engagement at the tested dose beyond the assumed antiplatelet effect.
“The primary non-inferiority outcome was the graft segment level rate of 100% SVG occlusion at one year after CABG.”
- 03Treatment effect not shown to be clinically meaningful
The primary efficacy result is a non-inferiority claim with an absolute difference of -0.31% (95% CI -3.13% to 2.52%) in SVG occlusion, which is not anchored to a clinically meaningful threshold. The non-inferiority margin was not based on a validated minimal clinically important difference.
“absolute difference −0.31%, 95% CI −3.13% to 2.52%; P=0.008 for non-inferiority”
This Kaimen Rigor review uses Kaimen Rigor reviewers trained on a curated corpus of high-fidelity and retracted papers, with expert supervision and curation. It can still make mistakes; verify each finding against the source before relying on it.
This is a well-conducted and well-reported multicentre RCT with strong design, ethics, and transparency. The main concerns are a truncated data availability statement and a statistical inconsistency in the reported non-inferiority p-value for the primary outcome, which warrant attention in a post-publication audit.
Both reviewers agreed on study type (interventional) and on all dimensions except statistical analysis and data code availability, where the deterministic verification components provided additional evidence. The statistics verification only recomputed a subset of tests (4 total), so the inconsistency in one p-value is a specific finding, not a blanket assessment of all statistics.
Numerical inconsistencies
1 finding · worst lowValues that contradict each other or are impossible for the stated sample: recomputed p-values and test statistics, GRIM/GRIMMER checks on summary numbers, percentages against their own counts, totals against their parts, and estimates against their own confidence intervals.
- Internal contradictions in the reported numbersAssessed
Recomputed 4 tests: 3 consistent, 1 inconsistent (1 change significance at p<.05); 2 recomputed directly from the reported test statistics, 2 via agent-written checks.
- CONSISTENTreported p < .001 · recomputed p = <.001Recomputed hazard ratio 0.62 (95% CI 0.48–0.81), reported p<0.001
“hazard ratio 0.62, 95% CI 0.48 to 0.81; P<0.001”
Taken as given: 0.48–0.81 is a two-sided 95% confidence interval for the hazard ratio of 0.62, not a range, an IQR, or a different interval level; the hazard ratio is a RATIO measure, so the interval is symmetric on the log scale; p<0.001 is the p for THIS estimate, not for another comparison in the same sentenceMethod: back the two-tailed p out of the log-scale CI width and compare it against the printed pHow we recomputed it: pCI(0.62, 0.48, 0.81, 1) - CONSISTENTreported p = .100 · recomputed p = .101Recomputed hazard ratio 0.76 (95% CI 0.55–1.06), reported p=0.10
“hazard ratio 0.76, 95% CI 0.55 to 1.06; P=0.10”
Taken as given: 0.55–1.06 is a two-sided 95% confidence interval for the hazard ratio of 0.76, not a range, an IQR, or a different interval level; the hazard ratio is a RATIO measure, so the interval is symmetric on the log scale; p=0.10 is the p for THIS estimate, not for another comparison in the same sentenceMethod: back the two-tailed p out of the log-scale CI width and compare it against the printed pHow we recomputed it: pCI(0.76, 0.55, 1.06, 1) - CONSISTENTreported p < .001 · recomputed p = <.001Reviewers 1, 2Superiority p-value for bleeding
“BARC type 2, 3, or 5 bleeding occurred in 95 patients (8.3%) in the three month DAPT group and 149 patients (13.2%) in the 12 month DAPT group (absolute difference −4.67%, 95% CI −7.18% to −2.16%; P<0.001).”
Taken as given: The absolute difference is -4.67% with 95% CI -7.18% to -2.16%.; The p-value is two-sided.; The CI is two-sided at 95%.Method: Recomputed p-value from the reported absolute difference and 95% CI using the normal approximation for a two-sided test.How we recomputed it: pCI(-4.67, -7.18, -2.16, 0)
- lowinternal contradictionThe abstract reports 2290 patients in the modified intention-to-treat set, but the results section states 2300 were randomized and 2290 comprised the mITT population. This is consistent, but the number of patients assessed at one year is 2070, which is lower than 2290, and the paper does not explicitly explain the discrepancy in the main text.
2290 patients (mean age 61.5 (standard deviation (SD) 8.4) years, 20.6% (n=472) women) were included in the modified intention-to-treat set. ... 2070 patients (90.4%) with a total of 5125 saphenous vein graft segments were assessed at one year.
Abstractreviewer’s wording
Overstated conclusions
4 findings · worst criticalConclusions that reach past what the paper's own results support — including a significance claim that no longer holds when the statistic is recomputed, and efficacy resting on an unvalidated surrogate endpoint.
- Significance claim flips when recomputedRecomputed
- Efficacy rests on an unvalidated surrogate endpointAssessed
- Treatment effect not shown to be clinically meaningfulAssessed
- Conclusions only partially backed by the presented evidenceAssessed
- SIGNIFICANCE OVERSTATEDINCONSISTENTreported p = .008 · recomputed p = .830Reviewers 1, 2Non-inferiority p-value for SVG occlusionReported as statistically significant, but recomputing from the paper’s own numbers gives p ≥ 0.05 — the result may not be significant as claimed.
“Saphenous vein graft occlusion occurred in 280 of 2596 (10.8%) in the three month DAPT group and 283 of 2529 (11.2%) in the 12 month DAPT group (absolute difference −0.31%, 95% confidence interval (CI) −3.13% to 2.52%; P=0.008 for non-inferiority).”
Taken as given: The absolute difference is -0.31% with 95% CI -3.13% to 2.52%.; The p-value is for a one-sided non-inferiority test.; The CI is two-sided at 95%.Method: Recomputed p-value from the reported absolute difference and 95% CI using the normal approximation for a one-sided test.How we recomputed it: pCI(-0.31, -3.13, 2.52, 0)
5 major claims checked against the paper's own evidence: 1 only partially supported (evidence backs part of the claim; gaps or caveats remain); the rest adequately supported.
- partialReviewer 1The three month DAPT strategy does not appear to confer an excess risk of graft occlusion in patients with a higher ischaemic burden.The subgroup analysis in patients with SYNTAX score >32 showed no statistically significant increased risk, but the trial was not powered for subgroup differences.Evidence: Among patients with higher ischaemic complexity (SYNTAX score >32), the three month DAPT strategy was not associated with a statistically significant increased risk of SVG occlusion compared with the 12 month strategy, despite a numerically higher event rate.
“Among patients with higher ischaemic complexity (SYNTAX score >32), the three month DAPT strategy was not associated with a statistically significant increased risk of SVG occlusion compared with the 12 month strategy, despite a numerically higher event rate.”
DiscussionFind in source - supportedReviewer 1A three month DAPT strategy was non-inferior to the 12 month DAPT strategy in saphenous vein graft occlusion.The primary outcome analysis shows non-inferiority with a p-value of 0.008 for non-inferiority, and sensitivity analyses support the finding.Evidence: Primary outcome: SVG occlusion 10.8% vs 11.2%, absolute difference -0.31% (95% CI -3.13% to 2.52%), P=0.008 for non-inferiority.
“A three month DAPT strategy was non-inferior to the 12 month DAPT strategy in saphenous vein graft occlusion and was superior in reducing bleeding risk.”
AbstractFind in source - supportedReviewers 1, 2A three month DAPT strategy was superior in reducing bleeding risk.The primary superiority outcome shows a significant reduction in bleeding with a p-value <0.001.Evidence: BARC type 2, 3, or 5 bleeding occurred in 95 (8.3%) vs 149 (13.2%), absolute difference -4.67% (95% CI -7.18% to -2.16%), P<0.001.
“A three month DAPT strategy was non-inferior to the 12 month DAPT strategy in saphenous vein graft occlusion and was superior in reducing bleeding risk.”
AbstractFind in source - supportedReviewers 1, 2The findings for other secondary outcomes were also similar between the two groups.Secondary outcomes such as MACCE and SVG failure showed no significant differences, as reported in Table 2.Evidence: MACCE occurred in 26 (2.3%) vs 27 (2.7%), absolute difference -0.11% (95% CI -1.48% to 1.26%).
“The findings for other secondary outcomes were also similar between the two groups.”
AbstractFind in source - supportedReviewer 2A three month DAPT strategy was non-inferior to a 12 month DAPT strategy in saphenous vein graft occlusion.The primary non-inferiority outcome showed an absolute difference of -0.31% with 95% CI -3.13% to 2.52%, and the non-inferiority p-value was 0.008, which is below the pre-specified one-sided alpha of 0.025.Evidence: Primary outcome result: 280/2596 (10.8%) vs 283/2529 (11.2%), absolute difference -0.31%, 95% CI -3.13% to 2.52%, P=0.008 for non-inferiority.
“Saphenous vein graft occlusion occurred in 280 of 2596 (10.8%) in the three month DAPT group and 283 of 2529 (11.2%) in the 12 month DAPT group (absolute difference −0.31%, 95% confidence interval (CI) −3.13% to 2.52%; P=0.008 for non-inferiority).”
AbstractFind in source
Premise concern: surrogate not validated for clinical benefit; effect size not shown to be clinically meaningful.
- INADEQUATESurrogate endpointThe primary efficacy outcome is saphenous vein graft occlusion at one year, a surrogate for clinical outcomes. The paper does not provide evidence linking SVG occlusion to patient-important outcomes, nor does it demonstrate target engagement at the tested dose beyond the assumed antiplatelet effect.
“The primary non-inferiority outcome was the graft segment level rate of 100% SVG occlusion at one year after CABG.”
- INADEQUATEEffect sizeThe primary efficacy result is a non-inferiority claim with an absolute difference of -0.31% (95% CI -3.13% to 2.52%) in SVG occlusion, which is not anchored to a clinically meaningful threshold. The non-inferiority margin was not based on a validated minimal clinically important difference.
“absolute difference −0.31%, 95% CI −3.13% to 2.52%; P=0.008 for non-inferiority”
Data authenticity concerns
None foundAn adversarial read for patterns associated with data that may not be genuine: results that look too clean, implausibly large effects, duplicated data or images, and methods that do not match the results reported.
Checked — nothing surfaced.
Reporting gaps
None foundRequired detail the manuscript never states — study design, biological variables, ethics approval and consent, key resources, statistical reporting, data and code availability, and overall transparency.
Checked — nothing surfaced.
The introduction cites prior studies (DACAB, POPular CABG) and a meta-analysis showing ticagrelor-based DAPT reduces SVG occlusion but increases bleeding. The rationale for shorter DAPT is based on the temporal dynamics of platelet activation and graft healing. Limitations of prior research are addressed by noting the lack of testing of short-term DAPT in CABG patients.
“Studies have shown a statistically significant reduction in SVG failure with ticagrelor based dual antiplatelet therapy (DAPT) for 12 months, but at the expense of increased bleeding risk.”
“In this trial, the Timing of Platelet Inhibition after Coronary Artery Bypass Grafting (TOP-CABG), we tested the hypothesis that three months of DAPT with ticagrelor plus aspirin would be non-inferior to 12 months of treatment in SVG occlusion in patients undergoing CABG, while reducing the bleeding risk associated with prolonged treatment.”
“Recent trials support the efficacy and safety of short term DAPT after percutaneous coronary intervention, but such an approach has not been tested in patients with CABG.”
“Studies have shown a statistically significant reduction in SVG failure with ticagrelor based dual antiplatelet therapy (DAPT) for 12 months, but at the expense of increased bleeding risk.”
“The pathophysiology of SVG occlusion provides a biological rationale for short term DAPT after CABG, and data show that the thrombotic risk is highest in the early phase after surgery and decreases thereafter.”
“This sub-study laid the foundation for further research of similar interests, although it was a subgroup analysis with limited statistical power to draw a definitive conclusion.”
Randomization was centralized with site-stratified block randomization (block size 10). Blinding was double-blind with identical placebo and no reported breaches. Power analysis was provided with assumptions and sample size calculation. Inclusion/exclusion criteria were pre-specified. Outlier handling is addressed through pre-specified analysis populations and missing data imputation. Controls are inherent in the placebo-controlled design. Independent replication is not applicable for a single pivotal trial.
“Eligible patients were randomly assigned through a centrally interactive web response system to DAPT for either three months or 12 months in a 1:1 ratio using a site stratified block randomisation with a block size of 10 on postoperative day 5.”
“Patients, investigators, outcome assessors, adjudicators, and statisticians were blinded to treatment assignments.”
“With an annual occlusion rate of 10% in the DAPT group, a loss to follow-up of 10%, and an average of 2.1 SVG segments in each patient, we estimated that 2300 participants could provide at least 90% power at a one sided α of 0.025 to show a 3.5% non-inferiority margin in the SVG occlusion rate between the two groups.”
“Eligible patients were randomly assigned through a centrally interactive web response system to DAPT for either three months or 12 months in a 1:1 ratio using a site stratified block randomisation with a block size of 10 on postoperative day 5.”
“Patients, investigators, outcome assessors, adjudicators, and statisticians were blinded to treatment assignments.”
“With an annual occlusion rate of 10% in the DAPT group, a loss to follow-up of 10%, and an average of 2.1 SVG segments in each patient, we estimated that 2300 participants could provide at least 90% power at a one sided α of 0.025 to show a 3.5% non-inferiority margin in the SVG occlusion rate between the two groups.”
Sex is reported (20.6% women) and both sexes are enrolled, so sex_justified is not applicable. Age, weight, height, BMI, and health status (comorbidities) are reported in Table 1. Demographics are comprehensive. Species/strain and housing conditions are not applicable for a human trial.
“The mean age was 61.5 years (SD 8.4), and 472 (20.6%) patients were women.”
“Mean (SD) age (years) | 61.5 (8.4) | 61.3 (8.3) | 61.6 (8.5)”
“Diabetes | 988 (43.1) | 509 (44.2) | 479 (42.1)”
“The mean age was 61.5 years (SD 8.4), and 472 (20.6%) patients were women.”
“Mean (SD) age (years) | 61.5 (8.4) | 61.3 (8.3) | 61.6 (8.5)”
“Diabetes | 988 (43.1) | 509 (44.2) | 479 (42.1)”
The study was approved by the central ethics committee at Fuwai Hospital with approval number 2022-1774 and collaborating centres. All participants gave informed consent. Regulatory compliance is implied by adherence to data privacy framework and ICMJE disclosure, though not explicitly naming a framework like the Declaration of Helsinki.
“This study was approved by the central ethics committee at Fuwai Hospital (approval No 2022-1774) and the collaborating centres; all participants gave informed consent before taking part in the study.”
“All patients provided written informed consent.”
“Our trial was conducted in strict accordance with the data privacy and security framework of China, which is functionally aligned with the EU’s General Data Protection Regulation (see supplementary file, section S2).”
“This study was approved by the central ethics committee at Fuwai Hospital (approval No 2022-1774) and the collaborating centres; all participants gave informed consent before taking part in the study.”
“All patients provided written informed consent.”
“Our trial was conducted in strict accordance with the data privacy and security framework of China, which is functionally aligned with the EU’s General Data Protection Regulation (see supplementary file, section S2).”
The trial uses ticagrelor and aspirin as the investigational products, with doses and regimen specified. The manufacturer (Nanjing Zhengda Tianqing Pharmaceutical) is mentioned in funding. Statistical software (SAS 9.4 and R 4.4.2) is identified. Other bench resources are not applicable.
“The 12 month group received 90 mg ticagrelor twice daily plus 100 mg aspirin once daily for one year after CABG.”
“This trial received drugs from Nanjing Zhengda Tianqing Pharmaceutical.”
“All analyses were done using SAS (version 9.4) and R (version 4.4.2).”
“The 12 month group received 90 mg ticagrelor twice daily plus 100 mg aspirin once daily for one year after CABG.”
“All analyses were done using SAS (version 9.4) and R (version 4.4.2).”
“This trial received drugs from Nanjing Zhengda Tianqing Pharmaceutical.”
Tests are named (GEE, Cox, Fine-Gray, chi-square, Fisher's exact). Assumptions are verified (proportional hazards tested and landmark analysis used). Exact p-values are reported (e.g., P=0.008, P<0.001). Effect sizes with CIs are reported throughout. Software is identified. Data presentation includes Kaplan-Meier curves and per-group n. Mathematical plausibility checks are not applicable for large-N continuous outcomes.
“The generalised estimating equation model with a binomial distribution and log link function was used to estimate the between group absolute risk differences and risk ratios with 95% confidence intervals (CIs), accounting for within patient correlation of multiple graft segments.”
“As the proportional hazards assumption for the bleeding outcome was not met (P=0.0073) (supplementary figure S2), we conducted a prespecified 90 day landmark analysis to estimate the absolute differences and hazard ratios.”
“Saphenous vein graft occlusion occurred in 280 of 2596 (10.8%) in the three month DAPT group and 283 of 2529 (11.2%) in the 12 month DAPT group (absolute difference −0.31%, 95% confidence interval (CI) −3.13% to 2.52%; P=0.008 for non-inferiority).”
“The generalised estimating equation model with a binomial distribution and log link function was used to estimate the between group absolute risk differences and risk ratios with 95% confidence intervals (CIs), accounting for within patient correlation of multiple graft segments.”
“As the proportional hazards assumption for the bleeding outcome was not met (P=0.0073) (supplementary figure S2), we conducted a prespecified 90 day landmark analysis to estimate the absolute differences and hazard ratios.”
“Saphenous vein graft occlusion occurred in 280 of 2596 (10.8%) in the three month DAPT group and 283 of 2529 (11.2%) in the 12 month DAPT group (absolute difference −0.31%, 95% confidence interval (CI) −3.13% to 2.52%; P=0.008 for non-inferiority).”
The data availability statement says 'Deidentified data and codes underlying the results reported in this manuscript are openl...' (truncated in the provided text, but indicates open access). This suggests a concrete route. Repository deposit and accession numbers are not applicable for patient-level data, but code sharing is mentioned.
Trial registration number is provided (NCT05380063). Methods are detailed enough for replication. Reporting guideline adherence is implied by the structured abstract and CONSORT-like flow diagram, though not explicitly named. All outcomes are reported. Limitations are extensively discussed. Conclusions are proportional. Funding and COI are disclosed.
“Trial registration ClinicalTrials.gov NCT05380063 .”
“Firstly, a small proportion of patients did not complete the assessment of SVG occlusion and were excluded from the main analysis, which may potentially bias the results towards non-inferiority.”
“The TOP-CABG trial was funded by the National Clinical Research Centre for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences (NCRC2022001).”
“Trial registration ClinicalTrials.gov NCT05380063 .”
“Firstly, a small proportion of patients did not complete the assessment of SVG occlusion and were excluded from the main analysis, which may potentially bias the results towards non-inferiority.”
“Funding: The TOP-CABG trial was funded by the National Clinical Research Centre for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences (NCRC2022001).”
Registered (1 ID: ClinicalTrials.gov). No reporting guideline cited.
Broken references and links
None found · partly checkedReferences checked against Crossref, OpenAlex and Retraction Watch for retractions and resolvability, plus declared data and code links probed for whether they resolve to content matching the paper.
Nothing surfaced — but not everything feeding this category ran (missing: data/code link verification), so read this as a partial clean bill.
Checked 42 references by DOI: 42 verified.
Every extracted reference resolved against Crossref/OpenAlex with no retraction flags.
Copyediting
6 minorWording, consistency and formatting errors that need correcting before submission.
No major wording or formatting errors. 6 minor suggestions below.
6 copyedit issues flagged: mostly typo, consistency, clarity.
- MINORtypoAbstract, Results“20.6% (n=472) women”→ Consider rephrasing to '472 (20.6%) women' for consistency with the rest of the text.Minor style inconsistency.
- MINORconsistencyTable 2, footnote“P=0.008 for non-inferiority”→ Ensure the footnote is clearly linked to the primary outcome row.Clarity issue.
- MINORclarityData availability statement“Deidentified data and codes underlying the results reported in this manuscript are openl...”→ Complete the sentence to specify the repository or access mechanism.Truncated sentence.
- MINORtypoAbstract, Results“openl...”→ Complete the sentence: 'openly available'Truncated text in the data availability statement.
- MINORconsistencyTable 2, footnote“P=0.008 for non-inferiority”→ Ensure consistency in reporting p-values as exact or threshold.Some p-values are reported as <0.001, others as exact.
- MINORclarityMethods, Statistical analysis“We adjusted the type II error to half”→ Clarify the statistical adjustment for multiple testing.The phrase is ambiguous.
The published work is largely robust, but readers should weigh the discrepancy in the reported non-inferiority p-value (0.008 vs recomputed 0.83) and the incomplete data availability statement. An erratum or independent re-analysis of the primary outcome is warranted to resolve the p-value inconsistency.
- 1.CRITICALstatisticsResolve the statistics inconsistency that flips a significance claim: Recomputed 4 tests: 3 consistent, 1 inconsistent (1 change significance at p<.05); 2 recomputed directly from the reported test statistics, 2 via agent-written checks.Demonstrable critical failure — blocks the verdict from passing.
- 2.HIGHstatisticsRe-analyze the primary non-inferiority test for SVG occlusion and correct the reported p-value (currently P=0.008) if it is erroneous; the recomputed p-value is 0.83, which would change the conclusion.The reported p-value is inconsistent with the recomputed value, which could affect the non-inferiority conclusion and requires correction or clarification.
- 3.HIGHdata codeComplete the data availability statement to specify the repository or platform where deidentified data and code can be accessed, and provide a URL or contact.The current statement is truncated and does not provide a concrete access route, hindering reproducibility.
- 4.HIGHreportingExplicitly state adherence to the CONSORT reporting guideline in the methods or a separate section.The paper follows CONSORT-like structure but does not explicitly declare it, which is a reporting transparency gap.
- 5.MEDIUMreportingClarify the role of the funder in study design, conduct, and analysis, and specify any independence of the data and safety monitoring board.The funding statement is generic and does not clarify the funder's role, which is important for transparency.
- 6.MEDIUMreportingProvide the full statistical analysis plan as a supplementary file, as it is mentioned but not included.A full SAP would enhance transparency and allow readers to verify pre-specified analyses.
- 7.MEDIUMreportingReport the number of patients screened and excluded before randomization in the CONSORT flow diagram.The flow diagram is referenced but not shown in the main text; including it would improve transparency.
- 8.MEDIUMreportingAdd a statement on whether the study followed the Declaration of Helsinki or other ethical guidelines.While ethics approval is documented, explicit adherence to an ethical standard would strengthen the ethics section.
- 9.MEDIUMstatisticsReport exact p-values for secondary outcomes that are currently reported as thresholds (e.g., '>0.99' or '0.67').Exact p-values improve precision and allow readers to assess the strength of evidence.
- 10.LOWcopyeditFix the truncated sentence in the data availability statement ('openl...') to read 'openly available'.This is a typographical error that obscures the intended meaning.
- 11.LOWcopyeditClarify the phrase 'We adjusted the type II error to half' in the statistical analysis section.The phrase is ambiguous and should be reworded to describe the multiple testing adjustment clearly.
- 12.LOWcopyeditEnsure consistency in reporting p-values as exact or threshold across tables and text.Some p-values are reported as exact (e.g., 0.008) while others are thresholds (e.g., <0.001), which may confuse readers.
- 13.LOWcopyeditRephrase '20.6% (n=472) women' to '472 (20.6%) women' for consistency with the rest of the text.Minor style inconsistency in the abstract.
The star rating is the report’s one-glance summary. Every paper starts at 5★ and loses stars for the concrete problems the review finds — so a rating is never a vague average, it’s a running total you can read line by line under “How this rating was calculated.”
- Reporting — 8 dimensionseach dimension that fully fails−½★
- each dimension partially met−¼★
- Statistics · Integrity · Claimseach serious problem−1★
- each medium problem−½★
- Citationseach retracted or unverifiable reference−¼★
- Copyeditonly when the manuscript needs a full edit−½★
The rating never drops below 1★, and a demonstrable critical failure (an impossible statistic, a proven ethics violation) caps it at 1★ on its own — so the stars can never look healthy when the verdict is CRITICAL.
The rating draws on a panel of agents. Three independent Kaimen Rigor reviewers grade the eight dimensions below across several independent passes (the shown verdict is their majority vote — steadier than any single run), isolate the paper’s major claims and check its own evidence backs them, and flag integrity concerns. Alongside them, a citation agent resolves every reference against Crossref, OpenAlex, and Retraction Watch; a statistics agent recomputes reported tests; and rule-based checks verify that declared data/code links actually resolve. Full text is required — an abstract-only submission is not analyzed.
Graded against NIH, MDAR, ARRIVE 2.0, CONSORT, EQUATOR, and RRID guidelines. A dimension that doesn’t apply to the study type is skipped, never penalized.
This Kaimen Rigor review is model-assisted and is not a substitute for formal expert review. It complements human evaluation by surfacing potential methodological concerns — verify each finding against the source.