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首页> 外文期刊>The American Journal of Cardiology >Analysis of the Bypass Angioplasty Revascularization Investigation Trial Using a Multistate Model of Clinical Outcomes
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Analysis of the Bypass Angioplasty Revascularization Investigation Trial Using a Multistate Model of Clinical Outcomes

机译：使用临床结果多状态模型的旁路血管成形术血运重建研究试验分析

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Current cardiovascular randomized trials typically use composite outcomes. We hypothesized that the Bypass Angioplasty Revascularization Investigation (BARI) outcomes and conclusions would differ using a multistate model relative to the intervention for the composite outcome of death (D) and nonfatal Q-wave myocardial infarction (MI). We used a multistate model which uses transition paths to simultaneously assess multiple end points. Using the 10-year follow-up BARI data, we post hoc analyzed outcomes according to 3 transition paths: (1) from intervention to MI; (2) from intervention to death; and (3) from MI to death. Of 1,829 patients randomized to the intervention of percutaneous transluminal coronary angioplasty or coronary artery bypass grafting (CABG), 700 (38%) experienced the composite event D/MI which included 230 (13%) nonfatal MI and 470 (26%) death without antecedent nonfatal MI, whereas 79 of 230 (34%) experienced death after nonfatal MI. Outcomes of the 3 individual transition paths were analyzed by a multistate model. In contrast to standard survival analyses, after adjustment for baseline clinical covariates, outcomes after percutaneous transluminal coronary angioplasty or CABG were not significantly different for intervention to MI (p = 0.33) or intervention to death (p = 0.23), but MI to death favored CABG (p = 0.02). Deconstruction of the BARI data using a multistate model identifies a significant difference in individual transition-stage outcomes and therefore trial conclusions in contrast to the standard methods of survival analysis. These observations suggest multistate models should be considered in the design and analysis of randomized cardiovascular trials which use composite outcomes. (C) 2015 Elsevier Inc. All rights reserved.
机译：当前的心血管随机试验通常使用综合结果。我们假设相对于死亡（D）和非致命Q波心肌梗死（MI）的复合结果干预，使用多状态模型进行的旁路血管成形术血运重建研究（BARI）的结果和结论会有所不同。我们使用了一个多状态模型，该模型使用过渡路径同时评估多个端点。使用10年的随访BARI数据，我们根据3种过渡路径发布了特设分析结果：（1）从干预到心梗; （2）从干预到死亡; （3）从MI到死亡。在随机接受经皮腔内冠状动脉成形术或冠状动脉旁路移植术（CABG）干预的1,829名患者中，有700名（38％）经历了复合事件D / MI，包括230名（13％）非致命性MI和470名（26％）死亡，无前非致命性心肌梗死，而非致命性心肌梗死中有230人中有79人（占34％）死亡。通过多状态模型分析了3条单独过渡路径的结果。与标准生存分析相比，在对基线临床协变量进行调整之后，经皮腔内冠状动脉成形术或CABG后的MI干预（p = 0.33）或死亡干预（p = 0.23）的结果无显着差异，但MI致死更为有利CABG（p = 0.02）。使用多状态模型对BARI数据进行解构可发现各个过渡阶段结局之间存在显着差异，因此与标准的生存分析方法相比，试验结论更为明显。这些观察结果表明，在设计和分析使用综合结果的随机心血管试验时应考虑多状态模型。 （C）2015 Elsevier Inc.保留所有权利。

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