Abstract 18053: Prognostic Value of Anatomic versus Functional Diagnostic Testing in Symptomatic Patients With Suspected CAD: The PROMISE Trial (PROspective Multicenter Imaging Study for Evaluation of Chest Pain)
Bibliographic record
Abstract
Introduction: Symptoms suggestive of coronary artery disease (CAD) are common, but no randomized comparison of the prognostic value of coronary computed tomographic angiography (CTA) vs. functional testing has been performed. Methods: Patients (10,003) with suspected CAD were randomized to functional testing (exercise ECG, nuclear stress, or stress echo) or CTA. Site-based diagnostic test reports were classified as normal or mildly, moderately, or severely abnormal. Cox proportional hazards models assessed the relationship of test results to a composite of time to death, myocardial infarction, or unstable angina, and the discriminatory ability of the two tests was compared using the C-index. Adjusted HRs for events in patients with abnormal vs. normal test results were determined for CTA and functional testing. Results: Overall, 4516 patients received CTA and 4572 functional testing as the randomized diagnostic test. The proportions of normal, mild, moderate, and severe abnormalities on CTA were 33.3%, 42.7%, 10.0%, and 14.0%, respectively, and for functional testing 78.9%, 8.5%, 4.2%, and 8.4% (P=0.001). Event rates over 26.0 months’ (IQR 18.0, 34.4) follow-up were similar: CTA 137/4516 (3.0%) vs. functional 132/4572 (2.9%). Compared to patients with normal CTAs, those with abnormal CTAs had increasing HRs for events with increasingly severe abnormalities, while only patients with moderate and severely abnormal functional testing had an increased HR for events (Figure). The probability of having an event given a normal test result was lower for CTA compared to functional testing (0.9% vs. 2.2%; HR 0.47 [95% CI 0.26, 0.83]; P=0.009), but not significantly different for other test strata. The overall prognostic performance (C-index) of CTA vs. functional testing was 0.72 (0.68, 0.76) vs. 0.64 (0.60, 0.69); P=0.022 (see KM curves in Figure). Conclusions: In symptomatic patients with suspected CAD, CTA has better prognostic value than functional testing.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 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".