Abstract 4505: Presentation To Non-PCI Center Is Major Modifiable Factor Associated With Delayed Door-to-balloon Time In HORIZONS-AMI
Bibliographic record
Abstract
Introduction: Many pts with STEMI receive reperfusion later than recommended by current guidelines. Hypothesis: Factors associated with delayed door-to-balloon times (D2B) can identified; some may be modifiable. Methods: In the HORIZONS-AMI study, 3602 pts within 12 hours of onset of STEMI undergoing primary PCI were prospectively enrolled. Times were recorded for onset of symptoms, arrival at PCI center, arrival in catheterization laboratory, and first balloon inflation. Pts transferred from a non-PCI center to a PCI center were considered separately from pts presenting initially to a PCI center. Logistic regression using 29 demographic/historic variables and 6 pre-PCI adverse events (arrhythmias, CPR, hypotension, respiratory failure) identified factors associated with (1) first door-to-balloon time > 90 minutes, and (2) for each time interval, the highest quintile. Results: Complete time data was available for 2639 pts. Of 1848 pts presenting directly to a PCI center, 55% had D2B < 90 minutes. Of 781 pts transferred from a non-PCI center to a PCI center, 12% had D2B< 90 minutes. Presentation to a non-PCI center was the strongest predictor of D2B > 90 minutes (OR 9.1 compared to presentation to a PCI center, p < .0001). Other predictors of D2B > 90 minutes included history of congestive heart failure (OR 2.1, p = 0.0133), diabetes (OR 1.45, p = 0.002), prior MI (OR 1.43, p = 0.046), and baseline diuretic use (OR 1.36, p = 0.042), but not pre-PCI adverse events. Demographic factors correlated only weakly with delays in milestones between presentation and balloon inflation. Median D2B was similar for US (91 minutes) versus non-US pts (101 minutes, p = NS). After arrival at the cath lab, balloon inflation was delayed 1 hour (p < 0.001) in pts with prior CABG compared to pts without prior CABG. Conclusions: In HORIZONS-AMI, D2B < 90 minutes was achieved in only one half of pts presenting to a PCI center and one tenth of pts presenting to a non-PCI center. The only potentially modifiable factor observed in this study was presentation to a non-PCI center. This data highlights the need for ambulance triage of pts with chest pain to bypass non-interventional centers and deliver pts directly to primary PCI centers of excellence.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".