how to consider a patients would have more than one AMI events with more than 180 day gaps in hypertension Lancet article

[111yunxiang]

hello, i am confuse about how to deal with the situation that one patient might occur two or more primary outcome events with a difined gaps such as 180 days. i do not know how to handle this in cox regression you mentioned in Lancet hypertension article published in 2019. thank you for your answer

[schuemie]

A Cox regression will model the time to first occurrence after the index date (i.e. treatment initiation). However, we may allow for patients to be included in the study who have an AMI prior to the index date.

[111yunxiang]

I apologize for any confusion caused by my previous sentences. What I meant to say is that after initiating treatment, a hypertensive patient enters a follow-up observation period. During this period, if the patient experiences a first outcome event, such as an acute myocardial infarction (AMI), Cox regression analysis is used to estimate the time from medication initiation to the occurrence of the first AMI event. However, in the real world, a patient who experiences a first AMI event may also experience a second AMI event or another outcome event of interest, such as a stroke, within 6 months or after 6 months. In your Lancet article, how are these second outcome events addressed (second outcomes might the same type of first event (i.e., AMI) or a different event of interest, such as stroke) ?