Kaplan-Meier Curve

Kaplan-Meier

HR 95% CI p-value

? ?
DANISH NEJM
ESC 2016


Survival Analysis ?
clinical trial
intervention outcome outcome
event event
MI . HF
survival analysis
event
time-to-
event analysis analysis event
cumulative survival

Kaplan-Meier ?
Survival Analysis


event
Kaplan Meier
1958
conditional probability

probability of survival (0 1.0)
(0 ) Kaplan Meier Curve

1.0 ?
survival curve KM curve 1.0
prob 1.0 probability of event
(not survival)
KM
KM curve prob of survival
cumulative incidence prob of event clinician

cumulative Kaplan Meier risk estimate
Survival Curve ?

log-rank test log-rank statistic

Null Hypothesis
expected event rate
event rate


KM curve ( KM
curve) p-value chi-square reject null hypothesis (p < 0.05)


log-rank test ?
log-rank test survival curve

by
chance alone event binary response
log-rank statistic
survivial curve ?
Hazard Ratio
Hazard Ratio HR
KM curve
?

Hazard Ratio KM risk estimate ?

KM risk estimate risk
event % absolute
risk reduction HR Hazard ratio
odd
event

Hazard ratio
Proportional
Hazard Model assumption Cox Proportional Hazard
Model
Hazard Ratio Event Rate Reduction ?


Hazard ratio

( Cox Proportional model)

Event Rate Reduction ARISTOTLE Kaplan-
Meier method Hazard ratio Cox Proportional Hazard model
mean HR primary composite endpoint apixaban
warfarin 0.79 (0.66 - 0.95), p < 0.001
apixaban stroke

0.79 warfarin magnitude
Hazard rate
velocity 0.79 event
warfarin 100/79 = 1.26 event rate

outcome
Hazard ratio slope
magnitude x

Cox Proportional Hazard Model Hazard Ratio?

Proportional Hazard Model assumption Hazard Ratio
HR
(time-dependent covariate)

Proportional Hazard
violation Hazard Ratio
violation?

DANISH
DANISH Hazard
Ratio
Heart Failure
time-dependent covariate
DANSIH Schoenfeld
Schoenfeld ?
covariate Schoenfeld
residual plot Hazard ratio
Schoenfeld residual 0 0 PH violation
Schoenfeld residual test reject null hypothesis
(p < 0.05) violation DANISH Schoenfeld p value
0.054

Kaplan-Meier Curve, step-by-step

( 1412 Cardiology Seminar)
1. unit of measurement y
cumulative survival, cumulative probability (event rate)
cumulative Hazard rate ( Hazard ratio

) x y
cumulative rate y
inset y inset
plot cumulative survival
2. No. at risk 10
?
survival function attenuation
protocol cumulative
survival cumulative risk 12
protocol survival curve
minimal follow up time ( median follow up
time) manuscript x
aware

survival rate


3. survival curve





log-rank test reject null hypothesis
reject (p < 0.05)

pool interval
event union interval
probability
survival interval
n
estimated event rate
event rate
sum
2 degree of freedom = 1 ( n - 1)

Cox Proportional Hazard model log-rank test
null
hypothesis Hazard ratio = 1.0 reject (p < 0.05)
Hazard ratio 1 , Hazard ratio Hazard
rate , Hazard rate ? Hazard rate
 event next interval interval 0

instantaneous Hazard rate

Wipat