ST segment resolution in ASSENT 3: insights into the role of three different treatment strategies for acute myocardial infarction
Bibliographic record
Abstract
AIMS: ASSENT 3 (Assessment of the Safety and Efficacy of a New Thrombolytic) demonstrated that the bolus fibrinolytic tenecteplase (TNK), combined with enoxaparin (ENOX) or abciximab (ABCX), substantially reduced ischemic complications of acute myocardial infarction as compared with unfractionated heparin (UH). We compared ST resolution in each of the three treatment regimens in order to evaluate the speed, extent and stability of ST segment resolution and its relationship to the primary composite endpoint(s) of the trial. METHODS AND RESULTS: We evaluated ST segment shift and its subsequent resolution i.e. complete (> or =70%), partial (<70-30%) and no resolution (<30%) in 4,304 patients 60 and 180 min after treatment. Sixty minutes after therapy there was a trend for both half-dose TNK/ABCX and TNK/UH to have more frequent complete ST resolution (P=0.072) than TNK/ENOX. Pair-wise comparison at 60 min revealed that patients receiving TNK/ABCX had significantly more complete ST resolution than TNK/ENOX (P=0.026). Further ST resolution had occurred 180 min after treatment: complete ST resolution was greater with TNK/ABCX (59.2%) than the TNK/heparin (50.8%) and TNK/enoxaparin (50.8%) (P<0.001). In the TNK/ENOX group achieving complete ST resolution by 180 min, in-hospital reinfarction was 1.9% vs 4.2% for TNK/UH (P=0.015) representing a 2.3% absolute and 55% relative reduction in reinfarction. Thirty day and one year mortality was greatest amongst those patients with <30% ST segment resolution in the TNK/ABCX group. CONCLUSIONS: More rapid and complete ST resolution occurs with half-dose TNK/ABCX whereas less reinfarction occurs amongst those patients with > or =70% ST resolution receiving either TNK/ABCX or TNK/ENOX. These data highlight two potentially complementary mechanisms of clinical benefit associated with different pharmacologic regimens in acute myocardial infarction, i.e. more rapid versus more stable coronary patency.
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| 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, 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".