Results of Conservative Treatment Strategy in Patients with Unstable Angina and Low-Risk GRACE Score
Bibliographic record
Abstract
Цель. Разработать независимые критерии сердечно-сосудистых осложнений у пациентов с нестабильной стенокардией и низким риском по шкале GRACE для выделения группы лиц с необходимостью инвазивной стратегии в период госпитального лечения. Материалы и методы. В исследование включено 170 пациентов с нестабильной стенокардией, которые были выписаны из стационаров без визуализации коронарного русла. Пациенты приглашались на консультативный прием РНПЦ «Кардиология» для выполнения лабораторного тестирования и планирования последующей госпитализации. Период наблюдения составил 5 лет. Результаты. За период наблюдения повторно госпитализированы с нестабильной стенокардией 53% пациентов. По результатам коронароангиографии критическое стенозирование коронарных артерий зарегистрировано у 74% пациентов, отсутствие ангиографически значимых изменений выявлено у 26% человек. При консервативной стратегии лечения за 5 лет наблюдения повторная нестабильная стенокардия развилась у 51,2% пациентов, инфаркт миокарда – у 10% пациентов. Сердечнососудистая смертность составила 7%. Относительный риск развития комбинированной конечной точки за 5 лет наблюдения у пациентов с наличием критического стенозирования коронарных артерий составил 18,333, 95% ДИ 6,891–48,775; хи-квадрат Пирсона 80,402, р=0,000. За период наблюдения по результатам ангиографии 60% пациентов выполнено стентирование коронарных артерий, 14% пациентов – коронарное шунтирование, 26% – избрана консервативная стратегия ведения. Для прогнозирования повторных сердечно-сосудистыхосложнений достоверное значение имеют исходный уровень тропонина I, критическое стенозирование коронарных артерий и отягощенная наследственность по ИБС. Заключение. Учитывая большое число повторных сердечно-сосудистых событий в первый год наблюдения у пациентов с нестабильной стенокардией и низким риском по шкале GRACE, при условии критического стенозирования коронарных артерий, большинству пациентов необходимо выполнять визуализацию коронарного русла. Purpose. To develop independent criteria for cardiovascular complications in patients with unstable angina and low-risk GRACE for identifying a group of individuals requiring an invasive strategy during in-hospital treatment. Materials and methods. The study included 170 patients with unstable angina who were discharged from hospitals without coronary bed visualization. Patients were invited to a consultative appointment at the Republican Scientific and Practical Center of Cardiology to perform laboratory testing and to schedule subsequent hospitalization. Results. During the observation period, 53% of patients were re-hospitalized with unstable angina. According to the results of coronary angiography, critical stenosis of the coronary arteries was registered in 74% of patients; the absence of angiographically significant changes was detected in 26% of patients. During the 5-year follow-up under conservative treatment strategy, recurrent unstable angina developed in 51.2% of patients, and myocardial infarction in 10% of patients. The relative risk of combined endpoint developing during the 5-year follow-up in patients with critical coronary artery stenosis was 18.333, 95% CI being 6.891–48.775; Pearson’s chi-squared test was 80.402, p=0.000. During the observation period, based on the results of angiography, 60% of patients underwent coronary artery stenting, 14% of patients underwent coronary bypass grafting, and for 26% of patients a conservative treatment strategy was chosen. Baseline troponin I, critical coronary artery stenosis, and hereditary history of coronary heart disease are of significant importance in predicting recurrent cardiovascular complications Conclusion. Given the significant number of recurrent cardiovascular events in the first year of follow-up in patients with unstable angina and low-risk GRACE score, in cases of critical coronary artery stenosis, most patients require coronary bed imaging.
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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) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| 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) | 0.002 | 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".