Sex differences based on the timing of invasive management among patients with non-ST-elevation acute coronary syndrome: an individual patient data meta-analysis
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Bibliographic record
Abstract
Abstract Aims Studies investigating the timing of coronary angiography in non-ST-elevation acute coronary syndrome (NSTE-ACS) have not evaluated sex differences. This study aims to investigate the sex-related differences in outcomes of NSTE-ACS patients undergoing early or delayed invasive management. Methods and results An individual patient data (IPD) meta-analysis was performed after systematic review of randomized controlled trials (RCTs) comparing early vs. delayed invasive strategy among NSTE-ACS patients. The primary endpoint was a composite of all-cause death or myocardial infarction (MI) at 6 months. Secondary endpoints included all-cause death, MI, recurrent ischaemia, stroke, and major bleeding. One-stage, random-effects Cox models were conducted. This meta-analysis was registered with PROSPERO (CRD42023468604). Six RCTs including 6654 patients were identified, of whom 2257 (33.9%) were females with a median age of 69 years [interquartile range (IQR) 60–76], significantly higher than males (64.5 years, IQR 55–72.1, P < 0.001). Among patients undergoing early strategy, there was no sex difference in the occurrence of the primary [Hazard ratio (HR) 1.08, 95% confidence interval (CI) 0.83–1.41, P = 0.560] and secondary endpoints. Among patients undergoing delayed strategy, there was no difference in the occurrence of the primary endpoint (HR 1.12, 95% CI 0.88–1.43, P = 0.350). Female sex undergoing delayed strategy was associated with higher risk of recurrent ischaemia (HR 1.52, 95% CI 1.06–2.19, P = 0.023) and major bleeding (HR 1.88, 95% CI 1.22–2.87, P = 0.004) using univariable analysis but not using multivariable analysis. Conclusion No sex-related differences in the composite of all-cause death or MI were identified among NSTE-ACS patients undergoing early and delayed invasive management.
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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 | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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 it