Critical Pathway for Acute ST-Segment Elevation Myocardial Infarction
Bibliographic record
Abstract
BACKGROUND: Physicians are under increasing pressure to reduce costs and maintain high quality of care. Critical pathways may help accomplish this goal. METHODS: We assessed the potential impact of implementation of a critical pathway in the Thrombolysis in Myocardial Infarction (TIMI 9) Registry, in which 840 consecutive patients with ST-elevation myocardial infarction (STEMI) were enrolled at 20 hospitals in the United States and Canada. The proposed critical pathway targets 100% use of fibrinolysis in fibrinolytic-eligible patients, 95% use of aspirin, and 90% use of beta-blockers and angiotensin-converting enzyme inhibitors (ACE-I) and incorporates a strategy of early hospital discharge for low-risk patients. Risk reduction for each intervention was estimated based on the benefits seen in large randomized controlled clinical trials or meta-analysis. RESULTS: In the TIMI 9 Registry, fibrinolysis was used in 60% of the patients; primary percutaneous coronary intervention, in 9%; and no reperfusion therapy, in 31%. Only 87% of the registry patients took aspirin during hospitalization. Of those with documented left ventricular dysfunction or congestive heart failure, 32% were discharged on ACE-I; and of those with normal ejection fraction and no evidence of congestive heat failure, only 58% were treated with beta-blockers at discharge. For early benefit and by increasing the use of reperfusion therapy and aspirin to 95% and improving the time to treatment, one could potentially save 13 lives per 1,000 patients treated per year. Similarly, if beta-blocker and ACE-I use increased up to 90% for the long term, almost 2 lives per 1,000 patients treated per year could potentially be saved. In summary, by expanding the use of a critical pathway for thrombolysis in STEMI, 15 lives per 1,000 patients treated per year could be saved. To evaluate the potential economic impact of this critical pathway on low-risk patients, 358 of 505 thrombolysis patients had no recurrent ischemia, MI, shock, or congestive heart failure through day 5. Their median length of stay was 6.7 days (25-75th percentiles, range, 4.8-10.3 days), with 73% staying in-hospital more than the target of 5 days, with similar findings for patients treated with primary angioplasty. CONCLUSIONS: These findings demonstrate that significant opportunities exist for improving medical management of patients with acute MI. Critical pathways may help reduce costs while improving quality of care.
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How this classification was reachedexpand
Direct model labels (unvalidated)
Per-model category and study-design labels from the labeling rounds. They are machine output, unvalidated, and the disagreement between models ships as data. No study design here is MEDLINE-validated yet.
| Model arm | Categories | Study design | Confidence |
|---|---|---|---|
| gemma | no category Domain: not available · Genre: Other About the Canadian research system: no · About a Canadian topic: no | Not applicable | low |
| gpt | no category Domain: not available · Genre: Other About the Canadian research system: no · About a Canadian topic: no | Other design | low |
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 | 0.005 | 0.048 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.002 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 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, unvalidatedLabeled directly by 2 models reading the full record.
The models disagree on parts of this classification; every voice is preserved in the section at the end of the page.
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".