A logistic regression model when some events precede treatment: the effect of thrombolytic therapy for acute myocardial infarction on the risk of cardiac arrest

J Clin Epidemiol. 1997 Nov;50(11):1219-29. doi: 10.1016/s0895-4356(97)00125-x.

Abstract

When outcomes occur in clinical trials before treatment can be given, neither intent-to-treat nor according-to-protocol analyses give optimal estimates of the treatment effect. A better approach employs a time-dependent variable for treatment. Intent-to-treat analyses are conservative, biasing against treatment; according-to-protocol analyses bias in favor of treatment. We show how to measure the effect of a time-dependent variable in a logistic regression using person-time intervals as units of measurement and describe appropriate methods for reporting model performance. The method is applied to develop a model to predict the probability that a patient with a myocardial infarction will have a sudden cardiac arrest within 48 hours of presentation to emergency medical services both when treated with thrombolysis and when not treated. We use a time-dependent treatment variable because many patients went into cardiac arrest while awaiting treatment. This technique has been programmed into an electrocardiograph for real-time use in an emergency department.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Clinical Trials as Topic
  • Epidemiologic Methods
  • Heart Arrest / epidemiology*
  • Heart Arrest / etiology
  • Humans
  • Logistic Models
  • Middle Aged
  • Myocardial Infarction / drug therapy*
  • Probability
  • Regression Analysis
  • Risk Factors
  • Thrombolytic Therapy*