Prioritization of invasive coronary angiogram for deserving patients with chronic coronary syndrome (CCS) using an Angiogram Eligibility Scoring (AES) system - A Clinical Audit
Bibliographic record
Abstract
Abstract Funding Acknowledgements Type of funding sources: None. Introduction Many patients with CCS are usually referred for invasive treatment early on first come first serve basis. Proper clinical assessment of the severity of symptoms and optimization of the medical therapy lack before referral for invasive therapy due to increased workload and less man power. Patients with non-limiting symptoms are noticed to receive invasive therapy over medical therapy more. Recent ISCHAEMIA trial showed that invasive therapy is not associated with reduction in adverse ischaemic events compared to optimal medical therapy in CCS. Therefore, We implemented a scoring system to identify high risk CCS patients to receive invasive therapy Methods Angiogram eligibility scoring (AES) is given to patients according to age, gender, atherosclerotic risk factors, symptom profile, stress test findings and the history of myocardial infarction. Similar numbers of patients who underwent invasive angiography through first come first serve basis group and AES group over three consecutive months are compared. Patients in the AES group were called for invasive angiogram according to score in descending order. Each group of patients were analyzed for cardiometabolic risk factors, anginal symptoms, ejection fraction, angiography findings and revascularization plan. Results Patients came for invasive angiogram through AES had significant risk factors such as diabetes and dyslipidaemia (P<0.01). Limiting symptoms (Class 3-4 angina) and strongly positive stress test (P<0.01) are significantly high in AES group than first come first serve group. Ejection fraction is normal range in AES group (P<0.01). No significant difference found in the significant LMCA (>50%) plaque disease, severe (>70%) LAD and proximal LAD disease frequency, complexity in coronary artery disease and revascularization strategies between two groups (P>0.01). Conclusion AES system facilitated us to prioritize patients with limiting symptoms, strongly positive stress test and multiple atherosclerotic risk factors who would benefit from early invasive angiogram and revascularization over other patients with non-limiting symptoms and without non-invasive investigation before invasive angiography.
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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 | 0.007 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| 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".