High mortality with ST elevation myocardial infarction in a nontrial setting.
Bibliographic record
Abstract
BACKGROUND: Early mortality following ST elevation myocardial infarction (MI) is declining in trial and nontrial settings. Absolute rates in nontrial settings remain significantly higher than those seen in randomized controlled trials. It is unclear if this mortality difference is due to different patient characteristics or to less frequent use of reperfusion strategies. OBJECTIVES: To provide a descriptive analysis of contemporary management and outcome of ST elevation MI in a nontrial setting at a tertiary care hospital, and to compare the clinical characteristics and in-hospital mortality of patients with ST elevation MI who were or were not treated with reperfusion therapy. METHODS: A retrospective chart review of 115 patients with ST elevation MI from July 1999 to June 2000 was performed. RESULTS: Eighty-five of 109 (78%) eligible patients received reperfusion therapy--44% fibrinolysis, 27% primary percutaneous coronary intervention (PCI) and 7% rescue PCI. Twenty-two per cent of eligible patients received no form of reperfusion therapy. In-hospital mortality was higher among patients who received no reperfusion therapy than among those who had (50% versus 11%, respectively, P<0.001). Patients who did not receive reperfusion therapy were older, presented with a longer median duration of chest pain, had a higher incidence of Killip class III or IV, and had a higher mean Thrombolysis in Myocardial Infarction (TIMI) risk score; many had absolute or relative contraindications to fibrinolytic therapy, and a significant proportion presented with a duration of chest pain of 12 h to 24 h. CONCLUSIONS: Mortality in ST elevation MI is disproportionately higher among patients who receive no reperfusion therapy. Many of these patients have clinical characteristics that may affect the physician's decision to provide reperfusion therapy. Improving overall survival among patients with ST elevation MI will be contingent on optimizing the number of patients receiving reperfusion therapy.
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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 | 0.004 | 0.013 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".