BACKGROUND
Preventing in-hospital mortality in Patients with ST-segment elevation myocardial infarction (STEMI) is a crucial step.
OBJECTIVE
The objective of our research was to to develop and externally validate the diagnostic model of in-hospital mortality in acute STEMI patients used artificial intelligence methods.
METHODS
As our datasets were highly imbalanced, we evaluated the effect of down-sampling methods. Therefore, down-sampling techniques was additionally implemented on the original dataset to create 1 balanced datasets. This ultimately yielded 2 datasets; original, and down-sampling. We divide non-randomly the American population into a training set and a test set , and anther American population as the validation set. We used artificial intelligence methods to develop and externally validate the diagnostic model of in-hospital mortality in acute STEMI patients, including logistic regression, decision tree, extreme gradient boosting (XGBoost), K nearest neighbor classification model ,and multi-layer perceptron.We used confusion matrix combined with the area under the receiver operating characteristic curve (AUC) to evaluate the pros and cons of the above models.
RESULTS
The strongest predictors of in-hospital mortality were age, female, cardiogenic shock, atrial fibrillation(AF), ventricular fibrillation(VF),in-hospital bleeding and medical history such as hypertension, old myocardial infarction.The F2 score of logistic regression in the training set, the test set , and the validation data set were 0.7, 0.7, and 0.54 respectively.The F2 score of XGBoost were 0.74, 0.52, and 0.54 respectively. The F2 score of decision tree were 0.72, 0.51,and 0.52 respectively. The F2 score of K nearest neighbor classification model were 0.64,0.47, and 0.49 respectively. The F2 score of multi-layer perceptron were 0.71, 0.54, and 0.54 respectively.
The AUC of logistic regression in the training set, the test set, and the validation data set were 0.72, 0.73, and 0.76 respectively. The AUC of XGoBost were 0.75, 0.73, and 0.75 respectively. The AUC of decision tree were 0.75, 0.71,and 0.74 respectively. The AUC of K nearest neighbor classification model were 0.71,0.69, and 0.72 respectively. The AUC of multi-layer perceptron were 0.73, 0.74, and 0.75 respectively. The diagnostic model built by logistic regression was the best.
CONCLUSIONS
The strongest predictors of in-hospital mortality were age, female, cardiogenic shock, AF, VF,in-hospital bleeding and medical history such as hypertension, old myocardial infarction. We had used artificial intelligence methods developed and externally validated the diagnostic model of in-hospital mortality in acute STEMI patients.The diagnostic model built by logistic regression was the best.
CLINICALTRIAL
We registered this study with WHO International Clinical Trials Registry Platform (ICTRP) (registration number: ChiCTR1900027129; registered date: 1 November 2019). http://www.chictr.org.cn/edit.aspx?pid=44888&htm=4.
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