Abstract 9297: Incidence and Implications of Aborted Myocardial Infarction in STREAM
Bibliographic record
Abstract
Background: Timely and effective reperfusion therapy in patients (pts) with ST-segment elevation myocardial infarction (STEMI) may avoid significant necrosis. Aborted MI (AbMI) was a pre-specified (previously unreported) endpoint in the STREAM (STrategic Reperfusion therapy Early After MI) trial comparing a pharmacoinvasive strategy (Gp A) vs. primary PCI (Gp B) in STEMI pts presenting within 3 hours of symptom onset. Methods: 1754 pts with interpretable electrocardiograms (ECGs) and sequential biomarkers were included. AbMI was defined by successful reperfusion i.e. core laboratory assessed worst lead ST-elevation resolution ≥50% (90-min post-tenecteplase (TNK) in Gp A or 30-min post-PCI in Gp B), and minimal rise in biomarkers (≤2 times ULN rise in CK or CKMB) or if unavailable, ≤5xULN rise in troponin. All pts received heparin and clopidogrel at first medical contact. Results: In Gp A, 11.1% (n=99) had AbMI vs. 6.9% (n=59) in Gp B (p< 0.01). AbMI pts were younger, more often had prior MI, exhibited Killip I, had less baseline ΣST-deviation, and fewer Q waves within their acute infarct zone (Table). Within Gp A, AbMI pts had faster time to TNK and a lower all-cause death/shock/congestive heart failure (CHF)/re-MI than non-AbMI pts; this distinction was not evident in Gp B. Total ischemic time was 100 minutes longer in Gp B AbMI pts. Forty-five pts (i.e. 2.5%; evenly distributed by treatment) had masquerading MI with minimal biomarker elevation and persistent ST-elevation in sequential ECGs related to left ventricular hypertrophy, pericarditis, or early repolarization. Conclusions: These data demonstrate that fibrinolysis coupled with anti-thrombotic and antiplatelet therapy more frequently aborts MI: such pts have more favorable outcomes compared to non-AbMIs. Diligent review of ECG evolution in STEMI is necessary to distinguish AbMI from infarct masquerade.
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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 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 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".