Abstract 091: The Association of Invasive Treatment on Health Status Outcomes in Patients with Non-ST Elevation Myocardial Infarction and Pre-infarct Angina
Bibliographic record
Abstract
Introduction: Pre-infarct angina (PIA) in patients with non-ST elevation myocardial infarction (NSTEMI) is associated with better outcomes. However, the association of invasive strategy, as compared with ischemia-guided strategy, on health status outcomes for patients with PIA is not well studied. Methods: TRIUMPH and PREMIER are prospective myocardial infarction registries that collected the Seattle Angina Questionnaire (SAQ) at baseline, 1, 6 and 12 months. PIA was defined as a score of <100 on the SAQ Angina Frequency score at the time of patients’ acute myocardial infarction admission. Invasive strategy was defined as undergoing coronary angiography within 72 hours of admission without a preceding stress test. Propensity-adjusted mixed effect multivariable models were used to compare follow-up health status in patients with and without PIA based on treatment strategy. Results: Among 3,544 patients with NSTEMI, 1,839 (52%) had PIA, of whom 1,230 (67%) had an invasive strategy of whom 75% underwent revascularization. While patients who underwent invasive strategy had better health status at baseline than those who underwent ischemia-guided strategy, after propensity adjustment, patients’ comorbidities and characteristics were well balanced (all standardized differences <10%). An invasive strategy was associated with an improvement in SAQ angina frequency and SAQ summary score at 1 month only among patients with PIA (mean difference of 4 and 4.4 points, respectively, p <0.005), but this difference was not sustained at 6 or 12 months (Figure). However, among patients with no PIA, there was no significant difference in health status among patients who underwent an invasive or conservative strategy at all time points (mean difference at 1 month of 0.4 and 0.5 points on SAQ angina frequency and summary score, respectively, p >0.5 ). Conclusion: An invasive strategy for NSTEMI was associated with significantly better 30-day health status among patients with PIA, but not in those without. No health status benefits of an invasive strategy were observed at 6 or 12 months, regardless of PIA status.
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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 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 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".