Appropriate coronary revascularisation: Clinical outcomes in patients who do not receive it compared with those who do: The acre study
Bibliographic record
Abstract
Background. Underuse of coronary revascularisation may be investigated using expert panel ratings of appropriateness, yet there are no previous prospective clinical outcome studies. Objective To compare prospectively the clinical outcomes among patients appropriate for revascularisation in those who do not vs those who do undergo revascularisation. Design Prospective (median 30 months follow up), population based study of all patients undergoing coronary angiography (no exclusion criteria) during 1996/7. Clinical indications were rated as appropriate, uncertain or inappropriate by a 9 member expert panel prior to patient recruitment and assigned to patients at the time of angiography. Setting Royal Hospitals Trust, London. Participants 4021 patients undergoing coronary angiography. Main outcome measures All cause mortality (n=239) and angina status. Results At the time of angiography 582 patients were rated appropriate for PTCA; the 385 patients (66%) who did not undergo PTCA had worse follow up angina status than those who did (odds ratio 1.41 (95%Cl 1.0-2.0)). 943 patients were rated appropriate for CABG; the 419 (44%) who did not undergo CABG had worse angina status (odds ratio 2.15 (95%Cl 1.6-2.8)) and mortality (hazard ratio 2.48 (95%Cl 1.7-3.5)) than those who did. None of these associations was attenuated by adjustment for age, number of diseased vessels or other prognostic factors. Conclusion Patients judged appropriate for revascularisation but who did not receive it had worse clinical outcomes than those who did. The possibility that revascularisation is underused after angiography should be investigated.
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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 | 0.003 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
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".