Interplay Between Myocardial Bridging, Atherosclerosis, and Spasm in Patients With Nonobstructive Coronary Arteries
Bibliographic record
Abstract
Background Previous evidence suggested individual associations between myocardial bridging (MB), atherosclerosis, and epicardial vasospasm. The complex interplay between these 3 identities has not been well studied in the North American population. Methods All patients with angina and nonobstructive coronary arteries referred for coronary angiogram who underwent invasive coronary function testing (adenosine and acetylcholine provocation testing) at 2 North American centers between March 2016 and January 2021 were included. The prevalence of epicardial spasm (new >90% stenosis after acetylcholine injection) was assessed according to the presence of MB and moderate atherosclerosis (>50% stenosis or previously stented with negative fractional flow reserve). Results In total, 472 patients were included, from whom 18.4% (n = 87) had MB and 30.5% (n = 144) had moderate atherosclerosis. The overall prevalence of epicardial spasm was 27.8% (n = 132). Epicardial spasm occurred in 43.7% (n = 38) in patients with MB vs 24.4% (n = 94) in patients without MB ( P < .01), while it occurred in 39.6% (n = 57) in patients with moderate atherosclerosis vs 22.9% (n = 75) in patients with either mild or no atherosclerosis ( P < .01 for each). Epicardial spasm occurred in 19.1% (n = 50) of patients with neither moderate atherosclerosis nor MB, 35.8% (n = 44) of patients with moderate atherosclerosis alone, 37.9% (n = 25) of patients with MB alone, and 61.9% (n = 13) of patients with both MB and moderate atherosclerosis ( P < .01). Multivariate analysis confirmed that MB (odds ratio, 2.93; 95% CI, 1.67-5.13; P < .01) and moderate atherosclerosis were independently associated with epicardial spasm (odds ratio, 2.32; 95% CI, 1.18-4.59; P = .02). Conclusions Epicardial vasospasm occurs most frequently in patients with both MB and moderate atherosclerosis.
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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 | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.062 |
| Bibliometrics | 0.000 | 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".