Comprehensive Machine Learning-Enabled Outcome Prediction for Patients With Coronary Artery Disease Using Multicentre...

Treatment decision-making for patients with coronary artery disease (CAD) can benefit from accurate patient outcome prediction. Although previous studies have used machine learning (ML) to develop prediction models, they were mostly on the basis of small patient cohorts with strict inclusion and exclusion criteria, limited features, and only internal validation. We aimed to develop and externally validate ML models to predict short- and long-term outcomes for patients with obstructive CAD using large-scale multicentre patient data.

We used a comprehensive data set from patients with obstructive CAD who underwent coronary angiography at 3 hospitals in Alberta, Canada between 2009 and 2019. To predict all-cause mortality and major adverse cardiovascular events at 90 days, 1 year, 3 years, and 5 years, > 12,000 features were considered in an extensive ML framework. In addition to traditional ML models, we used a generative transformer-based tabular foundation model, Tabular Prior-Data Fitted Networks (TabPFN; Prior Labs, Freiburg im Breisgau, Germany). To study real-time feasibility, secondary analyses limited feature sets to commonly available preangiography data.

A total of 44,462 catheterizations from 38,767 patients were included. The median areas under the receiver operating characteristic curves of the best models, mostly TabPFNs, in external validation ranged from 0.796 to 0.845 and 0.694 to 0.755 for mortality and major adverse cardiovascular events, respectively. The minimum deployable preangiography feature set led to slightly lower but still reasonable performance.

The large sample size, extensive feature set, external validation, and transformer architecture led to personalized models with robust prediction performance. Our models have the potential to improve CAD treatment decision-making via accurate prognosis.