Long term outcomes of PCI and CABG for isolated proximal LAD lesions: a real world comparison
Bibliographic record
Abstract
Purpose: The clinical prognosis for untreated, high-grade proximal LAD lesions is poor. Previous studies investigating revascularisation strategies in this patient cohort have almost exclusively compared PCI using BMS with CABG in stable patients. We therefore compared clinical outcomes in patient's whom underwent revascularisation for isolated proximal LAD lesions in our institution. Methods: We undertook an observational cohort study of unselected, consecutive patients who underwent single vessel proximal LAD revascularization at a large university hospital from April 2000-August 2011. The clinical database was linked to the administrative Discharge Abstract Database of the Canadian Institute for Health Information and the Registered Persons Database. Due to significant differences in baseline variables between the groups propensity matching of the PCI to CABG cohorts was undertaken at a 2:1 ratio. Results: 1753 patients were included. 1596 had PCI and 157 patients underwent CABG. The mean follow up period was 5.5 years and 7 years respectively. The unadjusted mortality in the PCI group was 11.5% (n=183) and 7% (n=11) in the CABG group. Of the PCI patients 37.8% had DES implanted. The propensity matched PCI (n = 294) and CABG (n=147) cohorts were well balanced with respect to all baseline characteristics including age, diabetes, renal impairment, procedural urgency, presentation and LV impairment. There was no difference in mortality between the PCI group and CABG group: 1 year (0.3% vs. 0.7%), 5 years (3.1% vs. 4.8%; p=0.26). There were higher rates of revascularization in the PCI cohort at 1 year (10.9% vs. 0.7%) and at 5 years (17.3% vs. 1.5%; p<0.001). There was a trend towards higher cardiovascular events in the PCI group: at 5 years (19.7% vs. 10.9%; p=0.06) driven primarily by repeat revascularization. Conclusions: Revascularization by both PCI and CABG provide excellent mortality results in patients with isolated proximal LAD lesions. Repeat revascularization is more frequent in the PCI group.
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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 | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| 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".