Abstract 13464: Underutilization of Invasive Coronary Angiography Post Out of Hospital Cardiac Arrest: is a Paradigm Shift Needed?
Bibliographic record
Abstract
BACKGROUND: The immediate post-resuscitation 12-lead electrocardiogram (ECG) aids in the diagnosis of an acute coronary syndrome (ACS) following an out-of-hospital cardiac arrest (OHCA). Guidelines support immediate coronary angiography (CA) for a finding of acute ST-elevation (STE), no such recommendations exist for ST-depression (STD) post-OHCA. We aimed to assess the relationship of STE and STD on the post-resuscitation ECG with diagnostic CA findings. METHODS: A retrospective analysis of consecutive patients admitted to a Vancouver Hospital with CA capability post-OHCA, between November 2009 and December 2011. Patients were identified using the Resuscitation Outcomes Consortium Cardiac Arrest Registry and included if they had an interpretable post-resuscitation ECG. ST-segment changes >0.1mV in 2 contiguous leads were deemed significant. A stenosis ≤70% (or ≤50% for left main) was defined as obstructive coronary artery disease (CAD). RESULTS: Our cohort of n=231 pts had a mean age of 65±17y and 74% were males. The presenting rhythm was ventricular tachycardia/fibrillation (49%), pulseless electrical activity (19%), asystole (17%), and unspecified (15%). The post-resuscitation ECG demonstrated STE in 33%, STD in 27% and no ST abnormality in 40%. The QRS morphology included narrow complex (42%), intraventricular conduction delay (25%), RBBB (27%), and LBBB (6%). The rate of CA was 41% (n=94), with a mean LVEF of 42%. In Table 1 below the odd ratios describe the association of STE and STD with CA findings compared to patients with no ST abnormality. CONCLUSIONS: A high proportion of patients with OHCA demonstrated ST-segment abnormalities on the post-resuscitation ECG. The association with obstructive CAD was greatest with STE, the presence of STD showed a trend towards an association with both, occlusive and obstructive CAD. A randomized clinical trial is needed to assess the utility of diagnostic CA in OHCA patients with STD on the post-resuscitation ECG.
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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 | 0.007 | 0.039 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
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".