Abstract 17525: Warfarin Promotes Progressive Coronary Arterial Calcification: Insights From Serial Intravascular Ultrasound
Bibliographic record
Abstract
Background: Warfarin blocks the synthesis and activity of matrix Gla protein (MGP), a vitamin K-dependent inhibitor of arterial calcification. The impact of warfarin on coronary arterial calcification in vivo is unknown. This study compared serial changes in coronary percent atheroma volume (PAV) and calcium index (CaI) in patients treated with and without warfarin. Hypothesis: Serial changes in coronary CaI are greater in warfarin-treated patients compared with those not on warfarin, independent of changes in PAV Methods: In a patient-level analysis of 8 prospective randomized trials using serial coronary intravascular ultrasound, we compared changes in PAV and CaI in matched arterial segments in patients with coronary artery disease treated with (n=171) and without (n=4129) warfarin during an 18-24-month period. Results: Patients (age 57.9±9.2 yrs; male 73%; prior and concomitant statin use: 73 and 97% respectively) demonstrated an overall increase in PAV by 0.18±0.06% (p=0.003 compared with baseline) and CaI [median (IQR)] by 0.04 (0.00, 0.11) (p <0.001 compared with baseline). Following propensity-weighted adjustment for clinical trial, clinical characteristics and laboratory parameters, there was no difference in annualized ΔPAV in the presence and absence of warfarin treatment (0.08±0.05 vs. 0.13±0.04%, p=0.41). Following adjustment for PAV, a greater annualized increase in CaI was observed in warfarin treated patients [median (IQR) 0.03 (0.0-0.08) vs. no-warfarin: 0.02 (0.0-0.06) p<0.001)]. In a sensitivity analysis evaluating a 1:1 matched cohort (n=164 per group), significantly greater annualized changes in CaI were also observed in warfarin-treated patients. In a multivariable model, warfarin independently associated with an increasing CaI [Odds Ratio (95% confidence interval) 1.12 (1.01, 1.24), p=0.027]. Conclusion: Warfarin therapy associates with progressive coronary atheroma calcification, independent of changes in atheroma volume. The impact of these changes on plaque stability and cardiovascular outcomes require further investigation.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| 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 | 0.000 |
| 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".