P3680The high-risk ECG pattern of ST-elevation myocardial infarction: a substudy of the randomized trial of primary PCI with or without routine manual thrombectomy (TOTAL trial)
Bibliographic record
Abstract
Background: Both Q waves and inverted T waves in the presenting ECG are associated with a progressed stage of myocardial infarction (MI), possibly with less potential for myocardial salvage with reperfusion therapy in ST-elevation myocardial infarction (STEMI). The ECG pattern without Q waves and inverted T waves is defined as preinfarction syndrome (PIS), while ST elevation with Q waves and/or inverted T waves represents evolving myocardial infarction (EMI). Methods: In a substudy of the international, multicenter, prospective, randomized Trial of Routine Aspiration Thrombectomy with PCI versus PCI Alone in Patients with STEMI (TOTAL), we studied the prognostic impact of the PIS and EMI ECG patterns (n=7,860). The primary outcome was a composite of death from cardiovascular causes, recurrent MI, cardiogenic shock, or New York Heart Association (NYHA) class IV heart failure within one year. Results: The primary outcome occurred in 271 of 2,618 patients (10.4%) in the EMI group vs. 322 of 5,242 patients (6.1%) in the PIS group (hazard ratio [HR], 1.73; 95% confidence interval [CI], 1.47 to 2.03; p<0.001). The rates of cardiovascular death (5.0% with EMI vs. 2.4% with PIS; HR, 2.10; 95% CI, 1.64 to 2.68; p<0.001) and the primary outcome plus stent thrombosis or target-vessel revascularization (13.7% vs. 9.6%; HR, 1.46; 95% CI, 1.27 to 1.67; p<0.001) were also higher in the EMI patients. Stroke rate at one-year follow-up was similar (1.0% with EMI vs. 0.8% with PIS; HR, 1.16; 95% CI, 0.71 to 1.89; p=0.559). The dynamic ECG pattern (EMI vs. PIS) was independently predictive of primary outcome in multivariable analysis (adjusted HR, 1.60; 95% CI, 1.34 to 1.90; p<0.001).
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| 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".