Question of the Week # 461

Q461) A clinical trial is evaluating an investigational new drug (Drug A) as compared with standard therapy (Drug B) in patients presenting to the emergency department with myocardial infarction (MI). The study enrolled a total of 3,000 subjects, 1,500 in each study arm. Follow-up was conducted at 45 days post-MI. The following are the results of the trial:

Endpoints Drug A Drug B P-Value
Primary:

·         Death from cardiovascular causes

134 210 0.03
Secondary:

·         Hyperkalemia

57 70 0.4

What is the relative risk of death from cardiovascular cause? (Round to the nearest whole number)

A. 36%
B. 42%
C. 57%
D. 64%
E. 72%

11 Responses

  1. c

  2. D

    • 134/ 1500 divided by 210/ 1500 = 134/210 = approximately 0.64

  3. A

  4. Query – is the question asking for relative risk of death from cardiovascular causes in drug A arm compared to drug B arm or relative risk of death from cardiovascular cause after a/c MI?

  5. i believe its asking relative risk of dying from cardiovascular cause compared to other causes of death in MI patient after so many days.

    But the answer choices are in %, risk of dying from cardiovascular causes is 2.7 times risk of dying from hyperkalemia. 134+210/57+70.

    so to find out % of death due to cardiovascular causes.

    134+210/all deaths (471) = 73%

    E.

  6. the problem is that if you use the relative risk formula RR= a/ a+ b/ c/c+d where a is the exposed group and c is the control, you get 93%. where a is the number with positive (bad) outcome and b is number with negative (good) outcome, so its assumes positive (bad ) outcome for the study group is 134, and for the control is 210..any ideas?

  7. Dr Red can you please explain these in detail.
    Thanks.

  8. please can we have an answer everyone here has a different answer

  9. I was kinda confused particularly, because this was a scenario for absolute risk reduction, NNT, NNH. Anyway. D seems to be the right answer, I agree.

  10. answer is D 134/1500 / 210/1500 x 100 = 64%, the control group has a higher number of MI deaths and hyperkalaemia, each arm has 1500 people, so the ratio is with the 1500

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