30-day outcome after percutaneous coronary angioplasty in nonagenarians: feasibility and specific considerations in different clinical settings.
Bibliographic record
Abstract
BACKGROUND: Nonagenarians have been systematically excluded from randomized trials dealing with invasive coronary strategies, resulting in a lack of evidence-based guidelines regarding the optimal approach in this population. AIM: To describe the clinical and procedural characteristics and outcomes of patients 90 years of age or older who were treated with percutaneous coronary interventions (PCI). METHODS: We evaluated the 30-day outcomes of patients 90 years or older who underwent PCI at our institution, comparing the ST-segment elevation myocardial infarction (STEMI) subgroup with the non-STEMI/unstable angina (UA) and stable angina (SA) subgroups, who had been referred for coronary angiography. RESULTS: Over the time period 2002-2011, we identified 45 nonagenarians (mean age, 93 years; range, 90-102 years). The majority (59%) presented with an acute coronary syndrome and underwent immediate coronary revascularization by PCI. Technical success rate was 90%. The frequency of in-hospital death, need for urgent coronary artery bypass surgery, periprocedural cerebrovascular accident, and major adverse cardiovascular and cerebral events was 11%, 4.5%, 4.5%, and 18%, respectively. At 30 days, mortality was exclusively related to the STEMI subgroup with hemodynamic instability, compared with the non STEMI/UA and SA population. CONCLUSIONS: In carefully selected nonagenarians, PCI in contemporary practice may be performed with a high technical success rate with relatively low morbidity and mortality. Questions are raised about the feasibility and outcome of invasive coronary strategies in the high-risk clinical subgroup of STEMI and hemodynamic instability.
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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 | 0.004 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 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 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".