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Marsal JR, Urreta-Barallobre I, Ubeda-Carrillo M, Osorio D, Lumbreras B, Lora D, Fernández-Felix BM, Oristrell G, Ródenas-Alesina E, Herrador L, Ballesteros M, Zamora J, Pijoan JI, Ribera A, Ferreira-González I. Sample size requirement in trials that use the composite endpoint major adverse cardiovascular events (MACE): new insights. Trials 2022; 23:1037. [PMID: 36539800 PMCID: PMC9769015 DOI: 10.1186/s13063-022-06977-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The real impact of the degree of association (DoA) between endpoint components of a composite endpoint (CE) on sample size requirement (SSR) has not been explored. We estimate the impact of the DoA between death and acute myocardial infarction (AMI) on SSR of trials using use the CE of major adverse cardiac events (MACE). METHODS A systematic review and quantitative synthesis of trials that include MACE as the primary outcome through search strategies in MEDLINE and EMBASE electronic databases. We limited to articles published in journals indexed in the first quartile of the Cardiac & Cardiovascular Systems category (Journal Citation Reports, 2015-2020). The authors were contacted to estimate the DoA between death and AMI using joint probability and correlation. We analyzed the SSR variation using the DoA estimated from RCTs. RESULTS Sixty-three of 134 publications that reported event rates and the therapy effect in all component endpoints were included in the quantitative synthesis. The most frequent combination was death, AMI, and revascularization (n = 20; 31.8%). The correlation between death and AMI, estimated from 5 trials¸ oscillated between - 0.02 and 0.31. SSR varied from 14,602 in the scenario with the strongest correlation to 12,259 in the scenario with the weakest correlation; the relative impact was 16%. CONCLUSIONS The DoA between death and AMI is highly variable and may lead to a considerable SSR variation in a trial including MACE.
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Affiliation(s)
- Josep Ramon Marsal
- grid.430994.30000 0004 1763 0287Cardiovascular Epidemiology and Research Unit, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Pg. Vall d’Hebron, 119-129, 08035 Barcelona, Spain ,grid.466571.70000 0004 1756 6246CIBER Epidemiology and Public Health, Madrid, Spain
| | - Iratxe Urreta-Barallobre
- grid.466571.70000 0004 1756 6246CIBER Epidemiology and Public Health, Madrid, Spain ,grid.432380.eBiodonostia Health Research Institute, Clinical Epidemiology, San Sebastián, Spain ,grid.414651.30000 0000 9920 5292Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, Donostia University Hospital, Clinical Epidemiology Unit, San Sebastián, Spain
| | - Marimar Ubeda-Carrillo
- grid.414651.30000 0000 9920 5292Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, Donostia University Hospital, Library Service, San Sebastián, Spain
| | - Dimelza Osorio
- grid.466571.70000 0004 1756 6246CIBER Epidemiology and Public Health, Madrid, Spain ,grid.411083.f0000 0001 0675 8654Health Services Research Group, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - Blanca Lumbreras
- grid.466571.70000 0004 1756 6246CIBER Epidemiology and Public Health, Madrid, Spain ,grid.26811.3c0000 0001 0586 4893Public Health Department, Miguel Hernandez University, Alicante, Spain
| | - David Lora
- grid.466571.70000 0004 1756 6246CIBER Epidemiology and Public Health, Madrid, Spain ,grid.512044.60000 0004 7666 5367Health Research Institute Hospital 12 de Octubre (imas12), Madrid, Spain ,grid.4795.f0000 0001 2157 7667Statistical Studies Department, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Borja M. Fernández-Felix
- grid.466571.70000 0004 1756 6246CIBER Epidemiology and Public Health, Madrid, Spain ,grid.411347.40000 0000 9248 5770Clinical Biostatistics Unit, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Gerard Oristrell
- grid.411083.f0000 0001 0675 8654Cardiology Department, Vall d’Hebron University Hospital, Barcelona, Spain ,grid.512890.7CIBER Cadiovascular Diseases, Madrid, Spain
| | - Eduard Ródenas-Alesina
- grid.411083.f0000 0001 0675 8654Cardiology Department, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Lorena Herrador
- grid.411083.f0000 0001 0675 8654Cardiology Department, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Mónica Ballesteros
- grid.466571.70000 0004 1756 6246CIBER Epidemiology and Public Health, Madrid, Spain ,grid.411083.f0000 0001 0675 8654Health Services Research Group, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - Javier Zamora
- grid.466571.70000 0004 1756 6246CIBER Epidemiology and Public Health, Madrid, Spain ,grid.411347.40000 0000 9248 5770Clinical Biostatistics Unit, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain ,grid.6572.60000 0004 1936 7486Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Jose I. Pijoan
- grid.466571.70000 0004 1756 6246CIBER Epidemiology and Public Health, Madrid, Spain ,grid.411232.70000 0004 1767 5135Clinical Epidemiology Unit, Cruces University Hospital, Barakaldo, Spain ,grid.452310.1Biocruces-Bizkaia Health Research Institute, Barakaldo, Spain
| | - Aida Ribera
- grid.430994.30000 0004 1763 0287Cardiovascular Epidemiology and Research Unit, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Pg. Vall d’Hebron, 119-129, 08035 Barcelona, Spain ,grid.466571.70000 0004 1756 6246CIBER Epidemiology and Public Health, Madrid, Spain
| | - Ignacio Ferreira-González
- grid.430994.30000 0004 1763 0287Cardiovascular Epidemiology and Research Unit, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Pg. Vall d’Hebron, 119-129, 08035 Barcelona, Spain ,grid.466571.70000 0004 1756 6246CIBER Epidemiology and Public Health, Madrid, Spain
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