Usefulness of canada acute coronary syndrome risk score for predicting no-/slow-reflow in ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention
Bibliographic record
Abstract
Abstract Background The no-/slow-reflow phenomenon following primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) patients is associated with a poor prognosis. Early identification of high-risk patients of no-/slow-reflow is critical. This study sought to evaluate the predictive ability of the Canada Acute Coronary Syndrome (C-ACS) risk score for no-/slow-reflow in these patients. Methods STEMI patients who underwent primary PCI were consecutively enrolled and divided into three groups based on the C-ACS score: 0, 1, and ≥2. The C-ACS score was computed using the four clinical variables evaluated at admission (1 point for each): age ≥75 years, heart rate >100 beats/min, systolic blood pressure <100 mmHg, and Killip class >1. No-/slow-reflow was defined as thrombolysis in myocardial infarction flow grade 0 to 2 after primary PCI. The predictive ability of the C-ACS score for no-/slow-reflow was evaluated by the receiver operating characteristic curve. Results Overall, 834 patients were enrolled, with 109 (13.1%) developing no-/slow-reflow. The incidence of no-/slow-reflow increased from the C-ACS 0 group to C-ACS ≥2 group (10.7% vs 17.7% vs 32.2%, respectively, p<0.001). After multivariable adjustment, the C-ACS score was an independent predictor of no-/slow-reflow (odd ratio 2.623, 95% confidence interval 1.948-3.532, p<0.001). Furthermore, the C-ACS score possessed good discrimination for no-/slow-reflow (area under the curve 0.707, 95% CI 0.653-0.762, p<0.001). Further subgroup analyses indicated a significant interaction of C-ACS score with patient sex (p for interaction =0.011). The independent association between C-ACS score and no-/slow-reflow was only observed in male patients (odd ratio 3.061, 95% confidence interval 1.931-4.852, p<0.001). During a median follow-up duration of 4.3 years, the C-ACS score was independently associated with major adverse cardiovascular events independently of the occurrence of no-/slow-reflow (p for interaction =0.212). Conclusion The C-ACS risk score could independently predict the no-/slow-reflow in STEMI patients undergoing primary PCI, particularly in male patients.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| 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".