ST-Segment Elevation Myocardial Infarction Following Left Internal Thoracic Artery-to-Coronary Bypass Secondary to Arterial Steal Phenomenon
Bibliographic record
Abstract
BACKGROUND: In the post-left internal thoracic artery (LITA)-to-coronary artery bypass graft (CABG) setting, anginal symptoms are associated with the presence of large, unligated LITA side branches. These symptoms are mediated by a variable arterial steal phenomenon. CASE SUMMARY: This report describes an atypical case of ST-segment elevation myocardial infarction (STEMI) following LITA-CABG secondary to a variable arterial steal phenomenon induced by both a branch variant of the LITA and an intercostal artery. Angiography-guided embolization of the branch vessels successfully resolved the patient's ischemia. DISCUSSION: STEMI secondary to LITA branch-mediated steal has not been previously reported. This case demonstrates that large LITA side branches can lead to myocardial infarction and that embolization of the relevant side branches is an effective treatment strategy. TAKE-HOME MESSAGES: Providers should be aware that LITA side branches, if not ligated during surgery, may lead to threatening coronary ischemia. If such side branches cannot be ligated intraoperatively, then intravascular embolization is an effective treatment strategy.
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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 | 0.001 | 0.000 |
| 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".