Late-Breaking Science Abstracts and Featured Science Abstracts From the American Heart Association's Scientific Sessions 2021 and Late-Breaking Abstracts in Resuscitation Science From the Resuscitation Science Symposium 2021
Bibliographic record
Abstract
Background: There is a class I indication for surgical aortic valve replacement (SAVR) in symptomatic patients with severe aortic stenosis (AS).However, indications for early SAVR in asymptomatic patients with severe AS and normal left ventricular function remain debated.Method: The Avatar trial is an investigator-initiated international prospective randomized controlled event-driven trial that evaluated the safety and efficacy of early SAVR in the treatment of asymptomatic patients with severe AS according to common criteria (valve area ≤1 cm 2 with aortic jet velocity >4 m/s or a mean transaortic gradient ≥40 mm Hg) and normal LV function (EF >50%).Negative exercise testing was mandatory for inclusion.The primary hypothesis was that early SAVR will reduce a primary composite endpoint comprising all-cause death, acute myocardial infarction, stroke or unplanned hospitalization for heart failure, as compared to conservative strategy following guidelines.The trial was designed as event-driven to reach at least 35 prespecified events.The study has been performed in 9 centers in 7 European countries.Results: Between June 2015 and September 2020, 157 patients (mean age 67 years, 57% men) were randomly allocated to early surgery (n=78) or conservative treatment (n=79).Data collection, including follow-up was completed in May 2021.The overall median follow-up was 32 months: 28 months in early surgery group and 35 months in the conservative treatment group with a total of 39 events.In the early surgery group, 72 patients (92.3%) underwent SAVR.In an intention-to-treat analysis, patients randomized to conservative strategy had significantly higher incidence of primary composite endpoint (26 vs. 13 in early surgery group, HR 0.46, 95% CI 0.23-0.90,p=0.02).Freedom from HF or all-cause death was also significantly lower in conservative treatment group as compared to the early surgery group (HR 0.40, 95% CI 0.19-0.84,p=0.013).Conclusion: In asymptomatic patients with severe AS, early SAVR reduced a primary composite of all-cause death, acute myocardial infarction, stroke or unplanned hospitalization for heart failure as compared to conservative treatment.This advocates for early aortic valve replacement once AS becomes severe regardless of symptoms.
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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 | 0.018 | 0.021 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.004 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.009 | 0.002 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.005 | 0.004 |
| Insufficient payload (model declined to judge) | 0.211 | 0.064 |
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".