Abstract 317: Implications of the Ischemia Trial Results on Appropriateness of Percutaneous Coronary Intervention for Stable Coronary Artery Disease: Insights From the Ncdr Cathpci Registry
Bibliographic record
Abstract
Background: The recent ISCHEMIA trial found that percutaneous coronary intervention (PCI) did not reduce rates of cardiovascular events (death, myocardial infarction) in patients with stable ischemic heart disease (SIHD), regardless of ischemic burden, but improved patients’ health status, if they had angina. These findings have significant implications for appropriate use criteria (AUC) for PCI and suggest that PCI in asymptomatic patients may be classified as rarely appropriate given the lack of cardiovascular event or health status benefit. Methods: Patients with SIHD, who were enrolled in the NCDR Cath-PCI registry v5, from April 1 st , 2018 to June 30 th , 2019 were included in this study. To examine the potential implication of the ISCHEMIA trial on AUC, we modified the AUC definition to reclassify PCIs in asymptomatic patients with SIHD (without left main coronary artery involvement) as rarely appropriate. We then compared the current and modified AUCs. Results: Our final analytical cohort included 324,715 patients (mean age 67.9 years, 11.3% non-Caucasian, 30.4% females). At baseline, comorbidities were common with 42.9% having diabetes, 56.8% being current or recent smokers and 16.0% having chronic lung disease. Based on the current AUC definition, 113,110 (34.8%) PCIs were classified as appropriate, 79,859 (24.6%) as maybe appropriate, 6,660(2.1%) as rarely appropriate, and 125,086 (38.5%) could not be classified. Recategorizing the AUCs based on ISCHEMIA, 51,502 (15.9%) PCIs were classified as rarely appropriate; with 22,753 being reclassified from maybe appropriate and 22,089 asymptomatic patients being reclassified from unclassifiable to rarely appropriate (Figure). Conclusion: One in five patients with SIHD who undergo PCI are asymptomatic and might not be considered rarely appropriate under current AUC. The ISCHEMIA trial may have large implications on the number and proportion of patients with SIHD considered to receive little to no benefit from elective PCI.
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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 | 0.061 | 0.156 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 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".