Real-world effectiveness of early revascularization in stable coronary artery disease with moderate or severe ischemia
Bibliographic record
Abstract
Background Comparative effectiveness studies may provide insights into generalizability of the ISCHEMIA trial to real-world patients. We evaluated the long-term effectiveness of revascularization within 90 days after detecting moderate or severe ischemia on myocardial perfusion imaging (MPI) in stable coronary artery disease. Methods All consecutive patients with moderate or severe ischemia (summed difference score ≥7) on single photon emission computed tomography MPI at a tertiary academic medical center were included (January 2003 to March 2020). Early revascularization (defined as percutaneous coronary intervention or coronary artery bypass grafting within 90 days) after MPI, was compared to those patients treated without early revascularization, excluding those with left main disease, severe chronic kidney disease, severe left ventricular dysfunction, recent acute coronary syndrome or heart failure hospitalization. Primary outcomes were cardiovascular death or the composite of cardiovascular hospitalization or cardiovascular death, and were tracked throughout the provincial healthcare system. Results 1530 patients (mean age: 65 years; 70 % male) were followed for a median of 9.9 years. After inverse-probability treatment weighting, early revascularization was associated with lower risks of cardiovascular death (3.76 % vs 8.93 %; HR 0.54, 95 % CI: 0.31–0.91, p = 0.022) and a reduction in the composite endpoint (33.73 % vs 43.94 %; HR 0.67, 95 % CI: 0.49–0.92, p = 0.013) compared to those treated without early revascularization. Conclusions Patients with stable coronary artery disease treated with early revascularization after MPI showing moderate or severe ischemia experienced lower risks of cardiovascular death and composite of cardiovascular hospitalization or cardiovascular death compared to those treated without early revascularization.
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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 | 0.004 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| 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".