P6049Regional differences in process of care and clinical outcome among patients with ST-elevation myocardial infarction in Canada and the United Kingdom
Bibliographic record
Abstract
Background/Introduction: Inter-country comparisons can serve as natural experiments to assess the effectiveness of alternative systems of care for homogenous patient populations. Purpose: We evaluated differences in clinical characteristics, reperfusion strategies employed, and clinical outcomes of patients hospitalized with an ST-elevation myocardial infarction (STEMI) in Canada and the United Kingdom (UK). Methods: We compared 6,547 Albertans and 1,345 Northern England patients hospitalized for STEMI from 2009 to 2013 enrolled in the Alberta Contemporary Acute Coronary Syndrome Patients Invasive Treatment Strategies (COAPT) and Algorithm for Comorbidities, Associations, Length of stay and Mortality (ACALM) registries, respectively. Results: As seen in the Table, Alberta patients were similar in age, but had fewer females than patients in the UK. Rates of hypertension and diabetes were higher in Alberta, but rates of heart failure and atrial fibrillation were higher in the UK cohort. A pharmacoinvasive (PI) approach (fibrinolysis + PCI) was used more frequently in Alberta while the majority of UK patients received primary percutaneous coronary intervention (PPCI). Almost 30% of patients received no reperfusion in Alberta. Median length of stay (LOS) was shorter in the UK. In a multivariable logistic regression model, there was no difference in 30-day mortality between the two regions (adjusted OR (aOR) 0.86, 95% CI 0.64–1.16, p=0.32). Shorter LOS was associated with reduced 30-day mortality (OR 0.89, 95% CI 0.87–0.92, p<0.01). There was a trend towards PI strategy being associated with lower risk (aOR 0.68, 95% CI 0.45–1.04, p=0.08), while no reperfusion was associated with a higher risk of 30-day mortality (aOR 2.16, 95% CI 1.69–2.76, p<0.001) compared to PPCI.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".