Abstract 6223: The Appropriateness of PCI in a Regional Registry is High
Bibliographic record
Abstract
Background. Evidence based medicine mandates constant examination of the appropriateness of care. The ACC/AHA/SCAI have published, and updated, PCI guidelines. We assessed the concordance between these guidelines and actual clinical practice in our region. Methods. We evaluated 16,670 consecutive patients undergoing PCI in 2005–2006 at 10 hospitals contributing data to our regional PCI registry. As per the guidelines, we categorized patients into 5 groups (asymptomatic/CCS I-II angina, CCS III angina, UA/NSTEMI, STEMI, patients with prior CABG). Detailed clinical data, including number of diseased vessels and lesion location, myocardium at risk, the probability of angiographic success, and the probability of procedural risk, were then used to categorize procedures within subgroups as follows: Class I (useful and effective); Class IIa (evidence favors usefulness/efficacy); Class IIb (usefulness/efficacy less well established); Class III (not useful or effective). Results. We were able to assign 16,350 patients (98.1%) to a clinical subgroup and within subgroups, to classify 98.9% of procedures. Class I procedures totaled 38.1%; Class IIa 56.0%; Class IIb 0.7%; Class III 4.1%; unclassifiable 1.1%. The class distribution varied by clinical group (Figure ). Of the 664 Class III procedures, 64.6% were asymptomatic/CCS I-II angina, 32.5% UA/NSTEMI, and 2.9% CCS III angina. Conclusion. In this recent, regional experience we found that over 95% of PCI procedures were either Class I or Class II. In northern New England, actual clinical practice closely follows the ACC/AHA/SCAI recommendations for PCI appropriateness. ACC/AHA/SCAI 2005 Guidelines for PCI
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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 | 0.015 | 0.072 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.002 |
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".