Abstract 9150: Re-Elevation of Troponin Following Percutaneous Coronary Intervention Significantly Predicts 1-Year Mortality in Patients with High-risk Non-ST-Segment Elevation Acute Coronary Syndromes
Bibliographic record
Abstract
Background: The prognostic value of cardiac troponin (cTn) elevation post PCI is controversial. Moreover, in high-risk NSTE ACS patients presenting with elevated necrosis markers, the ability to use cTn to detect post-PCI MI is especially challenging: primarily this relates to discriminating PCI-related elevation from natural evolution of presenting MI. We addressed this issue by reviewing each cTn trend during the index ACS admission in all patients undergoing PCI randomized in the EARLY ACS (n=5552) and SYNERGY (n=4647) trials. Methods: Time and cTn value (indexed by ULN) data pairs were plotted into graphics for each of 10,199 pts and independently reviewed by 2 physicians to detect post-PCI cTn (re)elevation (example in figure). Post-PCI cTn peak was identified for each plot, and the relationship between peak cTn post PCI and 1-year mortality was evaluated using Cox proportional hazard modeling, correcting for the 15 clinical variables of the EARLY ACS 1-year mortality model (including baseline cTn). Results: Patients were classified into 3 groups: (i) (re)elevation post PCI not evaluable because cTn values rising through the time of PCI (group 1; N=4427 [43%]; excluded from further analyses); (ii) cTn values stable/falling with post-PCI (re)elevation detected (group 2; N=4276 [42%]); (iii) cTn values stable/falling but without post-PCI (re)elevation (group 3; n=1496 [15%]). In the multivariable model including patients in groups 2 and 3, peak cTn post PCI was significantly associated with a 7% increase in hazard of death per each 10xULN increase (adj. HR 1.07; 95% CI 1.03-1.11; p=0.0008). Conclusion: We describe a methodology that allows clear differentiation of post-PCI cTn (re)elevation from presenting MI in over half of high-risk NSTE ACS patients undergoing PCI. This approach identified a highly significant relationship between post-PCI cTn and 1-year mortality and has relevance for the incorporation of cTn for definition of post-PCI MI.
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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 | 0.003 |
| 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 | 0.000 | 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".