Coronary Angiography Following Acute Myocardial Infarction in Ontario, Canada
Bibliographic record
Abstract
BACKGROUND: The role of scientific evidence in shaping recommendations on capacity targets and cardiovascular technology utilization is unclear. METHODS: The temporal growth in the use of coronary angiography services and the use of statins after an acute myocardial infarction (AMI) was determined for all patients older than 65 years admitted to any hospital in Ontario, Canada, between 1992 and 2004. A Bayesian change-point regression model was used to determine the rate of maximum uptake (inflection point) for use of cardiac catheterization service and statins after AMI. The inflection points were compared with the corresponding publication dates of the first positive evidence for outcome efficacy of use of cardiac catheterization service and statins after AMI as obtained from randomized control trials. RESULTS: The use of post-AMI coronary angiography closely mirrored overall temporal increases in cardiac catheterization capacity between 1992 and 2004 (r = 0.95, P<.001). The inflection point for post-AMI angiography service use was September 1998, 11 months before the publication of the first positive randomized controlled trial demonstrating benefit of routine post-AMI angiography. Conversely, the inflection point for statin therapy occurred in October 1998, 47 months after the publication of the first positive randomized controlled trial demonstrating the benefits of statin therapy for the secondary prevention of coronary artery disease. These findings were consistent regardless of the presence of on-site cardiac catheterization facilities at the admitting AMI institution and patient illness severity levels. CONCLUSION: The proliferation of cardiac catheterization in Ontario is attributable to factors other than the emergence of published scientific evidence.
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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 | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 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".