Machine learning for prediction of all-cause mortality in patients with suspected coronary artery disease: A 5-year multicentre prospective registry analysis

Manish Motwani, Damini Dey, Daniel S. Berman, Guido Germano, Stephan Achenbach, Mouaz H. Al-Mallah, Daniele Andreini, Matthew J. Budoff, Filippo Cademartiri, Tracy Q. Callister, Hyuk Jae Chang, Kavitha Chinnaiyan, Benjamin J.W. Chow, Ricardo C. Cury, Augustin Delago, Millie Gomez, Heidi Gransar, Martin Hadamitzky, Joerg Hausleiter, Niree HindoyanGudrun Feuchtner, Philipp A. Kaufmann, Yong Jin Kim, Jonathon Leipsic, Fay Y. Lin, Erica Maffei, Hugo Marques, Gianluca Pontone, Gilbert Raff, Ronen Rubinshtein, Leslee J. Shaw, Julia Stehli, Todd C. Villines, Allison Dunning, James K. Min, Piotr J. Slomka

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Abstract

Aims Traditional prognostic risk assessment in patients undergoing non-invasive imaging is based upon a limited selection of clinical and imaging findings. Machine learning (ML) can consider a greater number and complexity of variables. Therefore, we investigated the feasibility and accuracy of ML to predict 5-year all-cause mortality (ACM) in patients undergoing coronary computed tomographic angiography (CCTA), and compared the performance to existing clinical or CCTA metrics. Methods and results The analysis included 10 030 patients with suspected coronary artery disease and 5-year follow-up from the COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter registry. All patients underwent CCTA as their standard of care. Twenty-five clinical and 44 CCTA parameters were evaluated, including segment stenosis score (SSS), segment involvement score (SIS), modified Duke index (DI), number of segments with non-calcified, mixed or calcified plaques, age, sex, gender, standard cardiovascular risk factors, and Framingham risk score (FRS). Machine learning involved automated feature selection by information gain ranking, model building with a boosted ensemble algorithm, and 10-fold stratified cross-validation. Seven hundred and forty-five patients died during 5-year follow-up. Machine learning exhibited a higher area-under-curve compared with the FRS or CCTA severity scores alone (SSS, SIS, DI) for predicting all-cause mortality (ML: 0.79 vs. FRS: 0.61, SSS: 0.64, SIS: 0.64, DI: 0.62; P , 0.001). Conclusions Machine learning combining clinical and CCTA data was found to predict 5-year ACM significantly better than existing clinical or CCTA metrics alone.

Original languageEnglish
Pages (from-to)500-507
Number of pages8
JournalEuropean heart journal
Volume38
Issue number7
DOIs
Publication statusPublished - 2017 Feb 1

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All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Motwani, M., Dey, D., Berman, D. S., Germano, G., Achenbach, S., Al-Mallah, M. H., Andreini, D., Budoff, M. J., Cademartiri, F., Callister, T. Q., Chang, H. J., Chinnaiyan, K., Chow, B. J. W., Cury, R. C., Delago, A., Gomez, M., Gransar, H., Hadamitzky, M., Hausleiter, J., ... Slomka, P. J. (2017). Machine learning for prediction of all-cause mortality in patients with suspected coronary artery disease: A 5-year multicentre prospective registry analysis. European heart journal, 38(7), 500-507. https://doi.org/10.1093/eurheartj/ehw188