Abstract 9382: Reperfusion Delays and Outcomes Among ST-Segment-Elevation Myocardial Infarction Patients With and Without Cardiogenic Shock
Bibliographic record
Abstract
Introduction: Mortality remains high among STEMI patients with cardiogenic shock (CS), and rapid reperfusion has been shown to improve outcomes. However, the comparative benefits of shorter reperfusion times among STEMI patients with and without CS is unclear. Hypothesis: STEMI patients presenting with CS would have significantly greater increases in mortality and MACE as FMC-to-device time increased compared to non-CS patients. We hoped to identify a FMC-to-device time threshold below which outcomes were optimized for CS and non-CS patients. Methods: We performed a retrospective analysis using prospective data from the Vancouver Coastal Health Authority STEMI registry. We included all patients with STEMI who received PCI between January 1, 2010, and December 31, 2020. Patients were stratified based the presence of CS at the time of admission and assessed for the primary outcome of in-hospital mortality and the secondary outcome of an in-hospital major adverse cardiovascular event (MACE), defined as a composite of the first occurrence of mortality, cardiac arrest, heart failure, ICH/CVA/Stroke or reinfarction. Logistic regression was used to estimate the relationships between FMC-to-device time and the primary and secondary outcomes in the CS and non-CS groups. Results: 2929 consecutive STEMI patients were included, of whom 9.4% (n= 275) had CS. Median FMC-to-device time was 113.5 (IQR 93.0-145.0) minutes for CS patients and 103.0 (IQR 85.0- 130.0) minutes for non-CS patients. CS patients were more likely to have FMC-to-device times above guideline recommendations (76.6% vs. 54.1%, p <0.001) compared to non-CS patients. Between 60 and 90 minutes, for each 10-minute increase in FMC-to-device time, mortality for STEMI patients with CS increased by 5-8%, while for non-CS patients it increased by less than 0.5%. Compared to non-CS patients, those with CS had higher incidences of mortality (41.1% vs. 1.9%, p <0.001) and MACE (81.1% vs. 19.4%, p <0.001). Conclusions: Among STEMI patients undergoing primary PCI, reperfusion delays among CS patients are associated with significantly worse outcomes compared to non-CS patients. Strategies to reduce FMC-to-device times for STEMI patients specifically presenting with CS are needed.
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| 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".