Hadanny, A, Shouval, R, Wu, J orcid.org/0000-0001-6093-599X et al. (8 more authors) (2021) Predicting 30-day mortality after ST elevation myocardial infarction: Machine learning- based random forest and its external validation using two independent nationwide datasets. Journal of Cardiology, 78 (5). pp. 439-446. ISSN 0914-5087
Abstract
Background
Various prognostic models for mortality prediction following ST-segment elevation myocardial infarction (STEMI) have been developed over the past two decades. Our group has previously demonstrated that machine learning (ML)-based models can outperform known risk scores for 30-day mortality post-STEMI. The study aimed to redevelop an ML-based random forest prediction model for 30-day mortality post-STEMI and externally validate it on a large cohort.
Methods
This was a retrospective, supervised learning, data mining study developed on the Acute Coronary Syndrome Israeli Survey (ACSIS) registry and the Myocardial Ischemia National Audit Project (MINAP) for external validation. Patients included received reperfusion therapy for STEMI between 2006 and 2016. Discrimination and calibration performances were assessed for two developed models and compared with the Global Registry of Acute Cardiac Events (GRACE) score.
Results
The ACSIS cohort (2,782 included /15,212 total) and MINAP cohort (22,693 included/735,000 total) were significantly different in most variables, yet similar in 30-day mortality rate (4.3–4.4%). Random forest models were developed on the ACSIS cohort with a full model including all 32 variables and a simple model including the 10 most important ones. Features’ importance was calculated using the varImp function measuring how much each feature contributes to the data's homogeneity. Applying the optimized models on the MINAP validation cohort showed high discrimination of area under the curve (AUC) = 0.804 (0.786–0.822) for the full model, and AUC = 0.787 (0.748–0.780) using the simple model, compared with the GRACE risk score discrimination of AUC = 0.764 (0.748–0.780). All models were not well calibrated for the MINAP data. Following Platt scaling on 20% of the MINAP data, the random forest models calibration improved while the GRACE calibration did not change.
Conclusions
The random forest predictive model for 30-day mortality post STEMI, developed on the ACSIS national registry, has been validated in the MINAP large external cohort and can be applied early at admission for risk stratification. The model performed better than the commonly used GRACE score. Furthermore, to the best of our knowledge, this is the first externally validated ML-based model for STEMI.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | Crown Copyright © 2021 Published by Elsevier Ltd on behalf of Japanese College of Cardiology. This is an author produced version of an article published in Journal of Cardiology (JC). Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | ST-segment elevation myocardial infarction; Machine learning; Data mining; Outcome; Mortality |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Dentistry (Leeds) > Applied Health and Clinical Translation (Leeds) The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM) > Clinical & Population Science Dept (Leeds) |
Funding Information: | Funder Grant number British Heart Foundation PG/19/54/34511 |
Depositing User: | Symplectic Publications |
Date Deposited: | 28 May 2021 12:10 |
Last Modified: | 21 Nov 2024 15:21 |
Status: | Published |
Publisher: | Elsevier |
Identification Number: | 10.1016/j.jjcc.2021.06.002 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:174644 |
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