Associations and prognostic implications of myocardial tissue injury stages in ST-elevation myocardial infarction using the Canadian Cardiovascular Society classification
Bibliographic record
Abstract
AIMS: The recently proposed Canadian Cardiovascular Society (CCS) classification categorizes post-infarction tissue injury into four stages, potentially improving risk stratification and guiding cardioprotective strategies. Its clinical and prognostic relevance in ST-elevation myocardial infarction (STEMI) remains unclear. We aimed to compare clinical characteristics across CCS stages and validate their prognostic implications in STEMI. METHODS AND RESULTS: We analysed 1109 STEMI patients included in three prospective studies. Cardiac magnetic resonance (CMR) imaging was performed 3 (interquartile range 2-5) days after myocardial infarction (MI) and patients were classified as follows: Stage 1 (aborted MI), Stage 2 (MI with necrosis and absence of microvascular injury), Stage 3 (MI with necrosis and microvascular obstruction), and Stage 4 (MI with necrosis and intramyocardial haemorrhage). This analysis revealed distinct patterns of clinical presentation, biomarker profiles, and cardiac function across the different CCS stages. There were differences in adverse clinical event rates and mortality between CCS stages [major adverse cardiovascular event (MACE): 0.7%, 3.4%, 3.1%, and 15.7%, P < 0.001 and mortality: 0.7%, 1.7%, 0.9%, and 6.3%, P < 0.001]. The CCS stage had a moderate to good predictive value for MACE and mortality [area under the curve (AUC) 0.74 (95% CI: 0.68-0.80), P < 0.001 and AUC 0.71 (95% CI: 0.61-0.80), P < 0.001] at 12 months, respectively. CCS stages were independently associated with MACE in multivariable Cox regression [hazard ratio: 2.18 (95% CI: 1.70-2.78), P < 0.001]. CONCLUSION: This study describes clinical characteristics across CCS stages and provides insights into their prognostic implications in a large cohort of STEMI patients reperfused by percutaneous coronary intervention. These data should inform the use of CCS stages in future trial designs.
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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 | 0.007 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| 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".