Non-invasive Coronary Artery Disease Screening Based on Electrocardiogram Characteristics and Clinical Risk Factors

Coronary artery disease (CAD), an acute and life-threatening cardiovascular disease, is a leading cause of mortality and morbidity worldwide. Coronary angiography, the principal diagnostic tool for CAD, is invasive, expensive, and requires a lot of skilled effort. The current study aims to develop an automated and non-invasive CAD detection model and improve its performance as closely as possible to clinically acceptable diagnostic sensitivity. Electrocardiogram (ECG) characteristics are observed to be altered due to CAD and can be studied to develop a screening tool for its detection. The subject's clinical information can help broadly identify the high-cardiac-risk population and serve as a primary step in diagnosing CAD. This paper presents an approach to automatically detect CAD based on clinical data, morphological ECG features, and heart rate variability (HRV) features extracted from short-duration Lead-II ECG recordings. A few popular machine-learning classifiers, including support vector machine (SVM), random forest (RF), K-nearest neighbours (KNN), Gaussian Naïve Bayes (GNB), and multi-layer perceptron (MLP), are trained on the extracted feature space, and their performance is evaluated. Classifiers built by integrating clinical data and features extracted from ECG recordings demonstrated better performance than those built on each feature set separately, and the RF classifier outperforms other considered machine learners and reports an average testing accuracy of 94% and a G-mean score of 92% with a 5-fold cross-validation training accuracy of 95(± 0.04)%.Clinical relevance- The proposed method uses a brief, single-lead ECG recording and performs similarly to current clinical practices in an explainable manner. This makes it suitable for deployment via wearable technology (like smart watch gadgets) and telemonitoring, which may facilitate an earlier and more widespread CAD diagnosis.