Outcome of STEMI Patients With Reperfusion Delay of 120 Minutes or More Treated With the Pharmacoinvasive Approach vs PPCI: A Retrospective Study
Bibliographic record
Abstract
<h2>Abstract</h2><h3>Background</h3> Primary percutaneous coronary intervention (PPCI) and fibrinolysis have proved to be major discoveries regarding treatment of ST-segment elevation myocardial infarction (STEMI). The threshold at which PPCI becomes less favourable than fibrinolysis remains unclear and controversial. Trials have studied the impact of delayed reperfusion in relation to symptom onset, but to our knowledge, none have focused on the outcome of patients past the expected 120-minute window regarding first medical contact (FMC) in the concomitant era of PPCI and fibrinolysis. <h3>Methods</h3> STEMI patients who presented to a single PPCI-capable hospital, in the period from 2016 to 2020, and were treated with PPCI within 120 -240 minutes after FMC, and those who received fibrinolysis, were included. Outcomes of patients treated with delayed PPCI were compared to those of patients treated with fibrinolysis. The primary endpoint was a net adverse clinical event composite of all-cause mortality, myocardial re-infarction, ischemia-driven target-vessel revascularization, disabling stroke, and major bleeding at discharge. <h3>Results</h3> Inclusion criteria were met for 536 STEMI patients, 429 treated with PPCI and 107 treated with fibrinolysis. The primary endpoint (net adverse clinical events) was not significantly different between the 2 groups (2.8% vs 3.7%, <i>P</i> = 0.61). However, intracranial hemorrhage (0% vs 2.8%, <i>P</i> = 0.008) and bleeding (BARC 3 or 5) (0.9% vs 3.7%, <i>P</i> = 0.048) significantly favoured the PPCI group. <h3>Conclusions</h3> This retrospective study suggests that delayed PPCI may be a safer approach than fibrinolysis in patients with an FMC-to-balloon time of > 120 minutes, owing to reduction in the risk of intracranial and severe bleeding. These retrospective observations should be validated in larger randomized trials.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 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) | 0.000 | 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 teacher head, 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".