Cardio/Kidney Composite End Points: A Post Hoc Analysis of the EMPA¿REG OUTCOME Trial

• Type: Article in International Scientific Journal
• Date: 2021

Authors

Ferreira, JP (Author) FMUP; Kraus, BJ (Author) Other; Zwiener, I (Author) Other; Lauer, S (Author) Other; Zinman, B (Author) Other; Fitchett, DH (Author) Other; Koitka¿Weber, A (Author) Other; George, JT (Author) Other; Ofstad, AP (Author) Other; Wanner, C (Author) Other; Zannad, F (Author) Other

Journal

Title: Journal of the American Heart Association

Vol. 143

ISSN: 2047-9980

Publisher: Wiley-Blackwell

Other information

Authenticus ID: P-00V-8R4

DOI: 10.1161/jaha.120.020053

Abstract (EN): <jats:sec xml:lang="en"> <jats:title>Background</jats:title> <jats:p xml:lang="en">Cardio/kidney composite end points are clinically relevant but rarely analyzed in cardiovascular trials. This post hoc analysis of the EMPA¿REG OUTCOME (Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients) trial evaluated cardio/kidney composite end points by 2 statistical approaches.</jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Methods and Results</jats:title> <jats:p xml:lang="en">A total of 7020 patients with type 2 diabetes mellitus and established cardiovascular disease were treated with empagliflozin 10 or 25 mg (n=4687) or placebo (n=2333) on top of standard care. Cardio/kidney composite end points studied were: (1) cardiac or kidney death, kidney failure, hospitalization for heart failure, sustained decline in estimated glomerular filtration rate ¿40% from baseline, or sustained progression to macroalbuminuria; (2) cardiac or kidney death, kidney failure, hospitalization for heart failure, or sustained estimated glomerular filtration rate decline ¿40% from baseline; and (3) cardiac or kidney death, kidney failure, hospitalization for heart failure, or sustained doubling in serum creatinine from baseline. Cox regression using time¿to¿first¿event analysis and win ratio (WR) using hierarchical order of events were applied. Empagliflozin reduced the risk of all cardio/kidney composites. The results varied only slightly between Cox and WR (eg, composite 1: hazard ratio, 0.56 [95% CI, 0.49¿0.64]; WR, 1.76 [95% CI, 1.53¿2.02]. WR prioritizes events by clinical importance; in particular, all fatal events are evaluated, whereas Cox regression ignores deaths when preceded by nonfatal events. Of the 285 cardio/kidney deaths in the analysis, 44 to 56 (15%¿20%), depending on the composite, occurred after a nonfatal event and were not evaluated in Cox regression but evaluated by the WR.</jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Conclusions</jats:title> <jats:p xml:lang="en">By considering the clinical relevance of different event types, the WR represents an appropriate method to complement the traditional time¿to¿first¿event analysis in cardio/kidney outcomes.</jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Registration</jats:title> <jats:p xml:lang="en"> URL: <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://www.clinicaltrials.gov">https://www.clinicaltrials.gov</jats:ext-link> ; Unique identifier: NCT01131676. </jats:p> </jats:sec>

Language: English

Type (Professor's evaluation): Dissemination