Bibliographic record
Abstract
More Reasons to Use the Radial ArteryFurther Insights From the RAPCO Trial Article, see p 1330 I n patients with advanced multivessel coronary artery disease, coronary artery bypass grafting is the treatment of choice and is associated with improved survival and freedom from major adverse cardiac and cerebrovascular events. 1 The longterm durability of coronary artery bypass grafting is predicated on patent grafts, and understanding factors to improve graft patency remains critically important.There remains continued debate as to what the second best conduit is for the next most important lesion.2 There is mounting evidence to suggest a multiarterial grafting approach may improve survival and freedom from major adverse cardiac and cerebrovascular events compared with a single arterial grafting strategy.3,4 The RAPCO trial (Radial Artery Patency and Clinical Outcomes) was undertaken to better understand the arterial grafting hypothesis and to better define which is the second best conduit for coronary surgery.5 In this issue of Circulation, the eagerly awaited findings of the primary analysis of the RAPCO trials are published.5 The results were initially presented at the 96th Annual Meeting of the American Association for Thoracic Surgery in Baltimore, MD, in 2016.The RAPCO investigations are 2 separate angiographic randomized trials testing the superiority of the radial artery (RA) compared with either the free right internal thoracic artery (RITA) or saphenous vein graft (SVG) for graft patency over a follow-up of 10 years.Mortality was the other primary outcome, but sample sizes were not determined for the mortality end point.The RA to SVG comparison was the smaller of the 2 studies.In 225 patients randomized to either RA or SVG, RA patency was improved at 10 years (85% versus 71%), and the hazard ratio (HR) for graft failure was 0.40 (95% CI, 0.15-1.00).In contrast, the RA to RITA comparison was much larger.In 394 patients randomized to either RA or RITA, 10-year patency was significantly better with RA (89% versus 80%), with a HR of 0.45 for graft failure (95% CI, 0.23-0.88).Resulting 10-year survival was also improved in the RA group compared with the RITA group (HR, 0.53 [95% CI, 0.30-0.95]),whereas a significant improvement in survival was not demonstrated between RA and SVG (HR, 0.76 [95% CI, 0.47-1.22]).The study started recruitment in June 1996 and completed enrollment March 2005.To put the study in perspective, the published findings are now available >24 years after the first patient was randomized.For context, it is first important to understand some of the inherent limitations of graft patency studies such as RAPCO.Generalizability of findings may be limited because patients must be healthy enough to undergo protocol-driven coronary angiography; for example, this would exclude patients with renal insufficiency.There may be concerns about internal validity of the findings given incomplete ascertainment of the primary outcome in a proportion of patients.In RAPCO, per-protocol
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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 | 0.026 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.008 | 0.005 |
| Scholarly communication | 0.007 | 0.005 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.140 | 0.070 |
| Insufficient payload (model declined to judge) | 0.028 | 0.014 |
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".