Unlocking the mystery of cardiogenic shock in STEMI patients: why concordance matters and how PPCI can help
Bibliographic record
Abstract
Background: ST Elevation Myocardial Infarction (STEMI) complicated by cardiogenic shock (CS) is associated with significant morbidity and mortality which remains unchanged over the last decade. One potential reason is lack of concordance among CS defining parameters: (1) systolic blood pressure (SBP) <90 mmHg for ≥30 min or requiring vasopressors and/or mechanical support, (2) cardiac index (CI) ≤1.8 L/min/m2 or ≤ 2.2 L/min/m2 in the presence of inotropic agents/vasopressors, (3) lactate ≥ 2 mmol/L. Limited knowledge exists regarding the concordance among these three parameters in STEMI patients. Objectives: We aim to evaluate (1) incidence and concordance among these CS defining parameters in STEMI patients; (2) impact of primary percutaneous coronary intervention (PPCI) on these parameters, and (3) identify their association with outcomes. Material & methods: 204 STEMI patients were taken to cardiac catheter laboratory for primary PCI at the St. Boniface hospital were recruited by non-invasive cardiac system derived hemodynamic parameters, invasive blood pressure and lactate level on arterial blood gas analysis, pre-PPCI, post-PPCI, and POD-1. Results: The incidence of CS defining parameters pre-PPCI [SBP: 17 (8.5%); CI: 31 (15.5%); lactate 58 (29%)], post-PPCI [SBP: 17 (8.5%); CI: 18 (9%); lactate 35 (17.5%)] demonstrated a low-degree of concordance of three CS defining parameters. PPCI improved CI and lactate parameters, but not SBP. Adverse outcomes (death at 30 days and in-hospital stay >4 days) were observed in 21.6% patients and these patients were marked by low stroke index, pre-PPCI (28.99.5 vs 38.29.9) ml/m2, p<0.001; post-PPCI (29.410.5 vs 39.59.5) ml/m2, p<0.001 and POD-1 (28.79.5 vs 35.38.1) ml/m2, p<0.001, low CI at rest, [(2.40.9 vs 2.90.9) L/min/m2, p<0.05], low CPI at rest [(0.50.3 vs 0.60.2) Watt/m2, p<0.05], low CPO at rest [(0.90.6 vs 1.20.5) Watt, p<0.05], and low Granov-Goor Index, pre-PPCI (9.53.6) vs (12.43.6), p<0.001; post-PPCI (9.53.8) vs (12.83.8), p<0.001 and POD-1 (8.72.6) vs (10.72.8), p<0.001. Conclusion: Incidence of a CS defining parameter is significantly different in STEMI patients compared to non-ST elevation myocardial infarction (NSTEMI) and unstable angina (UA), and cannot be used interchangeably. PPCI improves these parameters, with the exception of SBP. Low SI, GGI were observed in patients experiencing adverse outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.044 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 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 source (direct Gemma or distilled Codex), 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".