Preoperative Intraaortic Balloon Pump Improves Early Outcomes Following High-Risk Coronary Artery Bypass Graft Surgery: A Meta-Analysis of Randomized Trials and Prospective Study Design.
Bibliographic record
Abstract
BACKGROUND: Despite widespread use, evidence to support preemptive intraaortic balloon pump (IABP) insertion for patients undergoing high-risk coronary artery bypass graft (CABG) surgery remains sparse, and in need of a well-defined clinical trial. To inform the design of a prospective trial, we sought to review outcomes in randomized controlled trials (RCTs) of anticipatory IABP use vs control in patients undergoing high-risk CABG through meta-analysis. The primary endpoint was all-cause mortality within 30 days of surgery. The secondary endpoint was major adverse cardiac and cerebrovascular event (MACCE), a composite of death, myocardial infarction, stroke, or repeat revascularization. METHODS: Using Ovid MEDLINE, we systematically reviewed all RCTs comparing preoperative IABP with control in patients undergoing high-risk CABG, defined as: left ventricular ejection fraction (LVEF) ≤40%, left main stenosis ≥70%, unstable angina, recent myocardial infarction, or prior myocardial revascularization undergoing elective or emergent CABG on or off pump. RESULTS: Of 950 articles assessed for eligibility, 10 RCTs of 1261 subjects (mean age, 65.0 years; 21.8% women; mean LVEF, 35%) were included. Mortality was significantly lower in patients receiving IABP compared with control (relative risk [RR], 0.48; 95% confidence interval [CI], 0.30-0.76; P<.01). The risk of MACCE was also lower with IABP (RR, 0.67; 95% CI, 0.54-0.84; P<.001). No significant differences in major bleeding events (RR, 1.27; 95% CI, 0.44-3.72) or vascular complications (RR, 1.13; 95% CI, 0.42-3.06) were detected. CONCLUSIONS: A strategy of routine prophylactic IABP use may reduce short-term mortality and MACCE in high-risk CABG patients. A definitive, adequately powered, prospective, randomized trial is warranted to confirm these results.
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How this classification was reachedexpand
Direct model labels (unvalidated)
Per-model category and study-design labels from the labeling rounds. They are machine output, unvalidated, and the disagreement between models ships as data. No study design here is MEDLINE-validated yet.
| Model arm | Categories | Study design | Confidence |
|---|---|---|---|
| gemma | no category Domain: not available · Genre: Empirical About the Canadian research system: no · About a Canadian topic: no | Meta-analysis | high |
| gpt | no category Domain: not available · Genre: Review About the Canadian research system: no · About a Canadian topic: no | Meta-analysis | high |
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 | 0.011 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.007 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| 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, unvalidatedLabeled directly by 2 models reading the full record.
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".