Expedited transfer for primary percutaneous coronary intervention: a program evaluation
Bibliographic record
Abstract
BACKGROUND: A shorter time from symptom onset to reperfusion is associated with improved outcomes for patients with ST-segment elevation myocardial infarction (MI). Primary percutaneous coronary intervention is a favourable method of reperfusion if performed effectively and expeditiously. We sought to evaluate the impact of an expedited pre-hospital diagnosis and transfer pathway developed by a multidisciplinary team on the door-to-balloon time in a large urban community. METHODS: We included all patients with ST-segment elevation MI who presented within 12 hours after symptom onset and who sought medical attention through Emergency Medical Services within the boundaries of the city of Calgary in the 16 months following the introduction of the pathway in June 2004. The primary aim was to determine the proportion of patients who received percutaneous coronary intervention within the recommended door-to-balloon time of 90 minutes. RESULTS: The 358 patients (268 men) in the study cohort had a mean age of 63.2 (standard deviation 12.7) years; 140 (39.1%) had an anterior MI; and 23 (6.4%) had cardiogenic shock. The introduction of the pathway resulted in a median door-to-balloon time of 62 (interquartile range 45-84) minutes. A door-to-balloon time within 60 minutes and within the currently recommended 90 minutes was achieved in 48.9% and 78.8% of the patients respectively. The in-hospital and 30-day mortality rates were both 3.1%. INTERPRETATION: In a community with multiple regional hospitals and a single facility for percutaneous coronary intervention, the implementation of a multidisciplinary pre-hospital diagnosis and transfer pathway was feasible and resulted in most patients in the study cohort receiving primary percutaneous coronary intervention within the recommended door-to-balloon time of 90 minutes.
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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 | 0.004 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".