Abstract 12701: Safety and Tolerability of Angiotensin Receptor Neprilysin Inhibitor Initiation in High-Risk Acute Myocardial Infarction Relative to Drug Initiation Setting: A Subgroup Analysis of the PARADISE-MI Trial
Bibliographic record
Abstract
Background: The initiation of blood pressure lowering pharmacologic agents during an acute myocardial infarction (AMI) can be challenging. The PARADISE MI trial randomised AMI patients with LV dysfunction and/or pulmonary congestion to either sacubitril/valsartan or ramipril within 7 days of presentation. At the physician’s discretion, drug initiation occurred in the inpatient (IP), day of discharge (DD), or outpatient (OP) setting. Objectives: To explore the safety and tolerability of sacubitril/valsartan versus ramipril when initiated in AMI in the IP, DD or OP care setting. Methods: Efficacy (cardiovascular death or incident heart failure), safety and tolerability were compared across initiation settings, and by randomization to either sacubitril/valsartan or ramipril. Results: Compared to IP, both DD and OP groups had fewer poor prognostic characteristics. Furthermore, serious adverse events were less frequent in the DD and OP compared to IP cohorts. The efficacy of sacubitril/valsartan on the primary outcome did not vary. Although overall adverse event rates were similar within initiation setting cohorts, systolic BP was lower with sacubitril/valsartan, regardless of initiation setting. The increased relative risk of hypotension with sacubitril/valsartan was similar across initiation settings. Conclusion: In this analysis of the PARADISE-MI trial based on drug initiation setting, sacubitril/valsartan reduced BP compared to ramipril. However, the clinical setting of drug commencement did not impact adverse event or tolerability signals between sacubitril/valsartan and ramipril.
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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 | 0.004 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.006 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 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".