Incidence and Predictors of Referral for Coronary Angiography and Revascularization in Non‐ST‐Segment Elevation Myocardial Infarction
Bibliographic record
Abstract
BACKGROUND: Routine invasive coronary angiography (ICA) is recommended for patients presenting with non-ST-segment elevation myocardial infarction (NSTEMI), but the rate of adherence to this recommendation in Australia is not known. AIMS: We sought to quantify the proportion of patients who undergo ICA and revascularization in a contemporary cohort of NSTEMI patients, and to determine predictors of clinical outcome. METHODS: This was a population-based cohort study of consecutive patients transported by emergency medical services (EMS) in Victoria, Australia with chest pain who were diagnosed with NSTEMI between January 1, 2015, and June 30, 2019. Ambulance data were linked to hospital admission, emergency department, and mortality records. RESULTS: There were 11,040 patients attended by EMS with NSTEMI, of which 5379 patients (48.7%) underwent ICA, with 2798 patients (25.3%) proceeding to coronary revascularization. Patients who underwent ICA were younger, more frequently male, less comorbid, and more likely to originate from a major city and a higher socioeconomic status compared to those who did not. Patients who underwent ICA had lower short- and long-term mortality, and coronary angiography was independently associated with reduced mortality on Cox-regression analysis (HR 0.45, 95% CI 0.41-0.50, p < 0.001). CONCLUSION: Less than half of ambulance-transported patients with NSTEMI underwent ICA, and only a quarter of the cohort received revascularization, despite there being a survival benefit with invasive management. Although patients who do not undergo ICA are older and more comorbid, there are potentially modifiable barriers to access to care, including socioeconomic status, rurality, and sex.
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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) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| 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".