The diagnostic accuracy of experienced physicians to clinically discriminate type 1 myocardial infarction from type 2 myocardial infarction or myocardial injury
Bibliographic record
Abstract
Abstract Background The early differentiation of patients with type 1 myocardial infarction (T1MI) from type 2 myocardial infarction (T2MI) or myocardial injury is crucial and has immediate clinical implications. It remains uncertain how precise experienced cardiologists (>10years experience) can discern a T1MI from T2MI or myocardial injury by solely integrating clinical information. Methods From a prospective, multicenter cohort study 1636 patients referred for urgent angiography for suspected T1MI, cardiologists were asked to estimate the likelihood of an underlying T1MI prior and following invasive angiography. All cases were independently reviewed and adjudicated for their final diagnosis (T1MI or T2MI/ myocardial injury). Results Finally, 1354 and 282 were adjudicated with T1MI and T2MI/myocardial injury, whereas 173 (17.2%) patients presented with myocardial injury, see Figure below. There was a male predominance, especially among patients with T1MI (1016 (75%), p<0.001). The prevalence of NSTEMI presentation was significantly higher in patients with T2MI/ myocardial injury. The level of hs-TnT at baseline was significantly higher in T1M1 compared to T2MI/ myocardial injury patients (133 (38; 571) ng/L versus 42 (26;92) ng/L and 68 (31; 212) ng/L, respectively; p=0.001). Overall, the number of angiography and PCI-related complications was low, but higher among T1MI compared to T2MI/ myocardial injury patients (0.4% versus 1.8%/ 0.0%, p=0.047, respectively). In terms of in-hospital adverse outcomes, the number of clinically relevant bleedings and revascularization procedures was higher in T1M1 compared to T2MI/ myocardial injury patients (9 (0.6%) versus 2 (1.8%), and 34 (2.5%) versus 3 (2.7%)). After 1-year follow-up (in unadjusted analyzes), the risk for MACE was higher among T1M1 compared to T2MI/ myocardial injury patients (230 (17%) versus 28 (7.3%), p=0.008). This was mainly driven by a higher risk for repeat revascularization procedures and MIs. Of note, there was no significant difference in death. Overall, we found that including the angiographic information had a significant impact on the diagnostic accuracy (p<0.001) (Figure). Prior to the invasive angiogram, the diagnostic accuracy of the cardiologists´ clinical evaluation and submitted likelihood for T1M1 reached an AUC 0.87 (95% confidence interval (95%CI) 0.85–0.90), and after integrating the angiographic information, the AUC increased (0.96 (95%CI 0.94–0.98). Conclusions Patients diagnose with T1M1 compared to T2MI/myocardial injury relevantly differ in their presentation and demographics as well as clinical outcomes. In order to reliably identify patients with T2MI/ myocardial injury and accordingly guide their further management, physicians should aim for delineation of the coronary anatomy. In this context, using invasive angiography with contemporary practice seems safe.Accuracy of clinical judgment for T1M1CONSORT diagram - study cohort
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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 | 0.005 | 0.025 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
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".