Deep-learning-based risk stratification for mortality of patients with acute myocardial infarction

PLoS One. 2019 Oct 31;14(10):e0224502. doi: 10.1371/journal.pone.0224502. eCollection 2019.

Abstract

Objective: Conventional risk stratification models for mortality of acute myocardial infarction (AMI) have potential limitations. This study aimed to develop and validate deep-learning-based risk stratification for the mortality of patients with AMI (DAMI).

Methods: The data of 22,875 AMI patients from the Korean working group of the myocardial infarction (KorMI) registry were exclusively divided into 12,152 derivation data of 36 hospitals and 10,723 validation data of 23 hospitals. The predictor variables were the initial demographic and laboratory data. The endpoints were in-hospital mortality and 12-months mortality. We compared the DAMI performance with the global registry of acute coronary event (GRACE) score, acute coronary treatment and intervention outcomes network (ACTION) score, and the thrombolysis in myocardial infarction (TIMI) score using the validation data.

Results: In-hospital mortality for the study subjects was 4.4% and 6-month mortality after survival upon discharge was 2.2%. The areas under the receiver operating characteristic curves (AUCs) of the DAMI were 0.905 [95% confidence interval 0.902-0.909] and 0.870 [0.865-0.876] for the ST elevation myocardial infarction (STEMI) and non ST elevation myocardial infarction (NSTEMI) patients, respectively; these results significantly outperformed those of the GRACE (0.851 [0.846-0.856], 0.810 [0.803-0.819]), ACTION (0.852 [0.847-0.857], 0.806 [0.799-0.814] and TIMI score (0.781 [0.775-0.787], 0.593[0.585-0.603]). DAMI predicted 30.9% of patients more accurately than the GRACE score. As secondary outcome, during the 6-month follow-up, the high risk group, defined by the DAMI, has a significantly higher mortality rate than the low risk group (17.1% vs. 0.5%, p < 0.001).

Conclusions: The DAMI predicted in-hospital mortality and 12-month mortality of AMI patients more accurately than the existing risk scores and other machine-learning methods.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease / mortality
  • Aged
  • Area Under Curve
  • Deep Learning
  • Female
  • Hospital Mortality
  • Humans
  • Machine Learning
  • Male
  • Middle Aged
  • Myocardial Infarction / mortality*
  • Non-ST Elevated Myocardial Infarction / mortality
  • ROC Curve
  • Registries
  • Republic of Korea / epidemiology
  • Risk Assessment / methods*
  • Risk Factors
  • ST Elevation Myocardial Infarction / mortality
  • Time Factors

Grants and funding

This research was supported by a fund (2013E2100200) by Research of Korea Centers for Disease Control and Prevention. This work was funded by the Korea Meteorological Administration Research and Development Program under Grant CATER 2012-3110. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.