A-2 | The impact of Adrenal Insufficiency on outcomes percutaneous coronary intervention in patients with ST elevation myocardial infarction
Bibliographic record
Abstract
Literature suggests that adrenal insufficiency could be associated with poor hospital outcomes in patients with ST elevation myocardial infarction (STEMI) and cardiogenic shock. Despite this, there remains a scarcity of data on outcomes of mortality, morbidity, and percutaneous coronary intervention (PCI) in patients admitted with STEMI as a function of adrenal insufficiency. This study was conducted to evaluate whether adrenal insufficiency is associated with poorer hospitalization outcomes in patients with STEMI. We queried the 2016-2019 National Inpatient Sample (NIS) database and identified ST elevation myocardial infarction (STEMI) as the primary diagnosis, with a co-diagnosis of adrenal insufficiency (AI). The primary outcome was the likelihood of PCI while the secondary outcomes included hospital mortality, the likelihood of pressors and/or mechanical ventilatory support, incidence of acute kidney injury (AKI) and the likelihood of temporary circulatory support use (tMCS). Multivariate linear and logistic regression models were used to adjust for demographics, Charleston comorbidity index, and hospital factors. Of all those admitted with a primary diagnosis of STEMI (N=690,430), 0.2% had a secondary diagnosis of adrenal insufficiency. Similarly, of those admitted for a diagnosis of STEMI, 69% were males, 73% were white, and 46% were Medicare patients. Patients with AI were less likely to receive PCI for a diagnosis of STEMI (80% vs. 66% and p<0.01). Inpatient mortality was higher (7.8% vs. 16%, adjusted OR 1.9, p<0.01) and as was the incidence of AKI (16% vs 41%, adjusted OR 3.3, p<0.01). Additionally, patients with AI were more likely to require pressors and/or mechanical ventilatory support (12% vs 31% and p<0.01) and tMCS (10% vs 22%, with p<0.01) during their hospitalization course compared to our control. Patients with adrenal insufficiency admitted for STEMI were less likely to receive PCI, despite being a sicker cohort with a higher inpatient mortality, a higher likelihood of pressor and/or mechanical ventilator support, higher need for tMCS and higher incidence for AKI.
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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 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 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".