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Published on: March 26, 2018
Machine learning-based predictive risk models for 30-day and 1-year mortality in severe aortic stenosis patients
Piyoros Lertsanguansinchai1, Ronpichai Chokesuwattanaskul2, Aisawan Petchlorlian3
1Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Cardiac Center, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand; Cardiology Center, Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand.
Background:
Predictive risk score for mortality plays an important role in the decision-making in patient selection and risk stratification for TAVI. Existing established predictive risk scores had poor discrimination performance in the prediction of mortality after the TAVI.
Objectives:
The present study aimed to develop machine learning-based predictive models for 30-day and 1-year mortality in severe aortic stenosis patients undergoing TAVI.
Methods:
A total of 186 patients in a retrospective cohort study were analyzed. The models were fitted by a decision tree. Each model was tested in 100 iterations of 80:20 stratified random splitting into training/testing samples and 10-fold cross-validation.
Results:
Variables that predict 30-day mortality are a set of factors driven mainly by height, chronic lung disease, STS score, preoperative LVEF, age, and preoperative LVOT VTI. Variables that predict 1-year mortality are a set of factors consisting of preoperative LVEF, STS score, heart rate, systolic blood pressure, home oxygen use, serum creatinine level, and preoperative LVOT Vmax. This decision tree-generated predictive models for 30-day and 1- year mortality provided the most precise accuracy of 0.97 and 0.90 with the AUC-ROC curves of 0.83 and 0.71 on 30-day and 1-year mortality on testing data and had better discrimination performance compared to the existing established TAVI predictive risk scores.
Conclusions:
These machine learning models show excellent accuracy and have a better prediction for 30-day and 1-year mortality than the existing established TAVI predictive risk scores. A customized predictive model deems to be properly developed for better risk discrimination among cohorts.
