Drip‑and‑ship for acute ST‑segment myocardial infarction. The pharmacoinvasive strategy for patients treated with fibrinolytic therapy
Bibliographic record
Abstract
Primary percutaneous coronary intervention (PCI) has been demonstrated to be superior to fibrinolytic therapy in reducing mortality in ST-segment elevation myocardial infarction (STEMI) when it can be performed rapidly. However, many STEMI patients present to hospitals without PCI capability and often cannot undergo PCI within the guideline-recommended timelines; instead, they receive fibrinolysis as the initial reperfusion therapy. Several studies have explored the potential of combining the best of both therapies by performing PCI soon after fibrinolysis, including TRANSFER-AMI (Trial of Routine Angioplasty and stenting after Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction). Patients (n = 1059) with anterior or high-risk inferior STEMI presenting to non-PCI centers within 12 h of symptom onset treated with tenecteplase and other standard antithrombotic therapies were randomized to either a pharmacoinvasive strategy (urgent transfer, angiography and PCI when appropriate within 6 h) or standard treatment (including rescue PCI, or angiography and PCI when appropriate beyond 24 h). The composite primary endpoint of 30-day death, reinfarction, recurrent ischemia, new or worsening heart failure, and cardiogenic shock occurred less frequently in the routine early PCI patients compared to the standard treatment patients (11.0% vs. 17.2%, P = 0.004). Based upon these findings, consistent with other studies, we believe that STEMI patients who cannot undergo timely primary PCI should receive prompt fibrinolysis followed by initiation of an immediate transfer to a PCI-capable hospital without waiting to see whether reperfusion is successful.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".