Novel Biomarkers, ST‐Elevation Resolution, and Clinical Outcomes Following Primary Percutaneous Coronary Intervention
Bibliographic record
Abstract
Background Despite restoration of epicardial flow following primary percutaneous coronary intervention ( PPCI ), microvascular reperfusion as reflected by ST ‐elevation resolution ( ST ‐ ER ) resolution remains variable and its pathophysiology remains unclear. Methods and Results Using principal component analyses, we explored associations between 91 serum biomarkers drawn before PPCI clustered into 14 pathobiologic processes (including NT‐ pro BNP [N‐terminal pro‐B‐type natriuretic peptide] as an independent cluster), and (1) ST ‐ ER resolution ≥50% versus <50%; and (2) 90‐day composite of death, shock, and heart failure. Network analyses were performed to understand interbiomarker relationships between the ST ‐ ER groups. Among the 1160 patients studied, 861 (74%) had ST ‐ ER ≥50% at a median 40 (interquartile range, 23–70) minutes following PPCI , yet both groups had comparable post‐ PPCI TIMI (Thrombolysis in Myocardial Infarction) grade 3 flow (86.6% versus 82.9%; P =0.25). ST ‐ ER ≥50% was associated with significantly lower pre‐ PPCI concentrations of platelet activation cluster (particularly P‐selectin, von Willebrand factor, and platelet‐derived growth factor A) and NT‐ pro BNP , including after risk adjustment. Across both ST ‐ ER groups, strong interbiomarker relationships were noted between pathways indicative of myocardial stretch, platelet activation, and inflammation, whereas with ST ‐ ER <50% correlations between iron homeostasis and inflammation were observed. Of all 14 biomarker clusters, only NT ‐pro BNP was significantly associated with the 90‐day clinical composite. Conclusions Suboptimal ST ‐ ER is common despite achieving post‐ PPCI TIMI grade 3 flow. The cluster of platelet activation proteins and NT‐ pro BNP were strongly correlated with suboptimal ST ‐ ER and NT‐ pro BNP was independently associated with 90‐day outcomes. This analysis provides insights into the pathophysiology of microvascular reperfusion in ST ‐segment–elevation myocardial infarction and suggests novel pre‐ PPCI risk targets potentially amenable to enhancing tissue‐level reperfusion following PPCI .
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| 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) | 0.001 | 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".