Document Detail

Validity of Composite Outcomes in Meta-Analyses of Stroke Prevention Trials: The Case of Aspirin.
MedLine Citation:
PMID:  21576939     Owner:  NLM     Status:  Publisher    
Background: Aspirin has been reported to be less effective for secondary vascular prevention in patients with ischaemic stroke, compared with other high-risk populations. This contention is largely based on results of meta-analyses that used a composite outcome of vascular death, myocardial infarction and stroke, reporting a 13% relative risk reduction. In this study, we explore whether the summary relative risk reduction for this composite outcome is representative of estimates for each of the individual components of the composite. Study Selection: All randomised controlled trials comparing aspirin with placebo/control in patients following ischaemic stroke or transient ischaemic attack, beyond the acute period (2 weeks). Data Analysis: A fixed-effects model was used and summary risk ratios were calculated for each of the outcomes: vascular mortality, recurrent non-fatal stroke, non-fatal myocardial infarction, composite of the latter three outcomes, all-cause mortality and non-vascular mortality. Results: Ten trials (n = 9,168) were included. For the composite of non-fatal stroke, non-fatal myocardial infarction and vascular death, aspirin was associated with a 13% reduction in risk (risk ratio, RR: 0.87; 95% CI: 0.81-0.94). For individual components of the composite, aspirin reduced the risk of non-fatal ischaemic stroke (RR: 0.81; 95% CI: 0.72-0.90) and non-fatal myocardial infarction (RR: 0.68; 95% CI: 0.52-0.87), but not vascular death (RR: 0.97; 95% CI: 0.86-1.1). Aspirin did reduce the risk of non-vascular death (RR: 0.79; 95% CI: 0.66-0.95), though, and had a trend towards a reduced risk of all-cause mortality (RR: 0.91; 95% CI: 0.81-1.01). Conclusions: Following ischaemic stroke, aspirin does not reduce the risk of vascular death, but provides a significant reduction in non-fatal stroke, myocardial infarction and non-vascular death. Our findings would support presenting the effect of aspirin therapy on individual outcomes rather than a composite including vascular death.
Emer McGrath; Aengus O'Conghaile; John W Eikelboom; Sean F Dinneen; Colin Oczkowski; Martin J O'Donnell
Related Documents :
4074839 - Quantitative 31p nuclear magnetic resonance analysis of metabolite concentrations in la...
176699 - Effects of glucagon on cardiac cyclic nucleotides in the hypoxic heart.
9118529 - Assessment of transmyocardial perfusion in alligator hearts.
22216169 - Rationale and design of the leipzig (life) heart study: phenotyping and cardiovascular ...
20174969 - Head to head comparison of quantitative versus visual analysis of contrast cmr in the s...
17659549 - Magnetic resonance imaging for ischemic heart disease.
20401439 - Cardiac and pulmonary alterations in symptomatic and asymptomatic dogs infected natural...
19787739 - Cardiovascular magnetic resonance reveals similar damage to the heart of patients with ...
8288409 - Difference in plasminogen activator inhibitor activity between non-q-wave infarction an...
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-5-11
Journal Detail:
Title:  Cerebrovascular diseases (Basel, Switzerland)     Volume:  32     ISSN:  1421-9786     ISO Abbreviation:  -     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-5-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9100851     Medline TA:  Cerebrovasc Dis     Country:  -    
Other Details:
Languages:  ENG     Pagination:  22-27     Citation Subset:  -    
Copyright Information:
Copyright © 2011 S. Karger AG, Basel.
National University of Ireland, Galway, Ireland.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Mania and Stroke: A Systematic Review.
Next Document:  First Experiences with a New Device for Mechanical Thrombectomy in Acute Basilar Artery Occlusion.