Outcomes and Care of Patients With Acute Heart Failure Syndromes and Cardiac Troponin Elevation
Bibliographic record
Abstract
BACKGROUND: Cardiac troponins (cTn) may be elevated among patients with acute heart failure syndromes (AHFS). However, the optimal approach to management of AHFS with elevated cTn is unknown. METHODS AND RESULTS: We compared the care and outcomes of 13 656 patients with AHFS seeking care in the emergency department stratified by presence (cTn+, n=1845, 13.5%) or absence (cTn-) of elevated troponin. Clinically abstracted data on patients who were admitted or discharged from the emergency department in Ontario, Canada (April 1999 to March 2001 and April 2004 to March 2007) were examined. In an exploratory 2:1 propensity-matched analysis, we examined whether early coronary revascularization (within 14 days of emergency department visit) was associated with survival, stratified by cTn status. For cTn+ AHFS, rates of coronary angiography (21.8 vs 11.4 patients/100 person-years; P<0.001) and coronary revascularization (8.8 vs 3.2 patients/100 person-years; P<0.001) were higher than cTn-. Instantaneous 30-day adjusted hazard ratios for cTn+ versus cTn- patients were 9.17 (95% confidence interval [CI], 8.31-10.12; P<0.001) for death, 5.14 (95% CI, 4.66-5.67; P<0.001) for cardiovascular readmission, and 13.08 (95% CI, 10.95-15.62; P<0.001) for ischemic heart disease hospitalization. In propensity-matched analysis of 143 individuals with cTn+ AHFS, early coronary revascularization was associated with reduced mortality (adjusted hazard ratio, 0.29; 95% CI, 0.09-0.92; P=0.036) compared with those who were not revascularized. Mortality was not significantly reduced among 210 cTn- patients undergoing early coronary revascularization (adjusted hazard ratio, 0.61; 95% CI, 0.36-1.03; P=0.065). CONCLUSIONS: Elevated cTn was associated with increased risk of death and cardiovascular hospitalizations. Highly selected cTn+ patients who underwent early coronary revascularization for obstructive coronary artery disease experienced improved survival.
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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 | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| 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".