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Abstract:
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In a cardiovascular outcomes trial subjects may experience a Major Adverse Cardiovascular Event (MACE), usually defined as the time to either non-fatal MI, or non-fatal stroke, or cardiovascular death, whichever occurs first. The traditional composite analysis consists of standard survival analysis of the time to the first event, so that each subject contributes a single event or right censored time. However, this fails to capture the total burden of disease, such as when a non-fatal MI is followed by cardiovascular death, the latter not entering into the analysis. This may also sacrifice power. We describe a simple multivariate one-dimensional test, originally proposed by Wei and Lachin, that can provide a more powerful approach to the analysis of multiple event times. The method can also employ weights to reflect the perceived relative severity of each outcome. The method is applied to a past-completed cardiovascular outcomes study.
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