P3607Temporal trends in the characteristics, management, and clinical outcomes of patients with prior myocardial infarction who are admitted with an acute coronary syndrome
Bibliographic record
Abstract
Abstract Background Patients with prior myocardial infarction (MI) are at increased risk for recurrent cardiovascular events. Advances in treatment in the last decade has improved prognosis of patients with acute coronary syndrome (ACS), yet it is not known whether similar trends exist in patients with prior MI who are admitted with an ACS, a particularly high-risk group. Methods Patients admitted with ACS who were enrolled in the ACS Israeli Surveys (ACSIS). Patients were stratified by early (2000–2008) and late (2010–2016) time-periods and by prior MI status. Clinical outcomes included 30-d MACE (death, MI, stroke, unstable angina, stent thrombosis, urgent revascularization) and 1-year mortality. Results A total of 15,211 ACS patients were included, of whom 4627 (30%) had a prior MI. These patients were older (67y vs. 63y), more commonly male, had more prior comorbidities, and a higher proportion had a GRACE score>140 (38.4% vs 12.2%). Patients with prior MI received more prior medications such as aspirin, statins, antihypertensives and hypoglycemics. During time, utilization of guideline-recommended therapies such as P2Y12 inhibitors, statins, and PCI had significantly improved in patients with prior MI. However, compared with patients without prior MI, they were still treated less commonly by PCI (61% vs. 74%). Overall, patients with prior MI had a higher 30-d MACE (13.7% vs 17.2%, p<0.001) and 1-year mortality (8.2% vs. 13.1%, p<0.001). In patients with prior MI, during time, 30d MACE nearly halved (22.7% to 11.8%) and 1-year mortality also decreased (15.5% to 10.7%). Upon adjustment, prior MI was independently associated with 1-year mortality (HR 1.13, 95% CI 1.01–1.26, p=0.04) and the late time-period was associated with reduced 1-year mortality (HR 0.75, 95% CI 0.65–0.84, p<0.001). Conclusion Patients with prior MI have a worse prognosis after ACS despite being treated with prior medications and improvement in guideline-based therapies. Although still undertreated, their clinical outcome has significantly improved throughout the years.
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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 | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 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".