Abstract P102: Characteristics of Practice of Primary Angioplasty in Quebec, Canada (2008-2009): A Systematic Field Evaluation
Bibliographic record
Abstract
Background: Primary angioplasty (PPCI) is the predominant reperfusion therapy for ST-elevation myocardial infarction (STEMI) in Quebec where there are 13 PPCI centers. Our systematic province-wide field evaluation examined contemporary practice of PPCI such as arterial access site and use of stents and thrombus aspiration devices. Methods: The 82 hospitals that treat over 95% of all acute myocardial infarctions occurring annually in Quebec participated in a systematic evaluation in 2008-9. Designated medical record librarians abstracted data from medical charts of patients with a final diagnosis of myocardial infarction who presented to an emergency room with characteristic symptoms. STEMI was confirmed by ECG interpretation. Results: Of 1876 treated STEMI patients, 1505 (80%) were sent for PPCI with 594 (39%) presenting directly to a PPCI center and 911 (61%) transferred from a non PPCI-capable center. Of these, 1334 patients (88 %) underwent PPCI. Almost all (1265/1334; 95%) had stent insertion (12% were drug-eluting stents). The radial approach was used in 844 (63%) patients with a median 12 min (6-21; all ranges 10-90 percentile) from first arterial puncture to first device. Patients with a femoral approach had a similar median delay [11 min (6-25)]. Door-to-balloon times were similar: 98 min (55-203) for the radial approach and 101 min (50-207) for the femoral approach. The first reperfusion device was a balloon in 687 patients (52%), a thrombus aspiration device in 485 patients (37%), and a direct stent in 145 patients (11%). Median delays from first puncture to first device were 13 min (7-26) for balloon, 10 min (6-18) for thrombus aspiration device, and 12 min (6-25) for direct stent deployment. There was substantial variation in radial versus femoral approach and type of first device by PPCI center. Conclusion: This contemporary evaluation of a complete system of STEMI care shows that most PPCI is performed in patients transferred from another hospital. The radial approach now predominates. The most frequent first reperfusion device is still the balloon but a substantial proportion of patients undergo thrombus aspiration. Drug eluting stent use was infrequent. Treatment delays did not vary by either arterial access site or type of first device.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".