3D Spatiotemporal cardiac reconstruction for predicting MACE in acute myocardial infarction

Artificial intelligence has made significant strides in predicting major adverse cardiovascular events (MACE) in patients with acute myocardial infarction (AMI) following percutaneous coronary intervention. However, most existing methods rely solely on tabular variables derived from clinical data and cardiac magnetic resonance (CMR), without fully leveraging the predictive potential of the CMR imaging modality itself. Moreover, these approaches often overlook the synergistic benefits of multimodal integration between imaging and tabular data. In addition, current models primarily focus on short-term MACE risk assessment (e.g., within 6 months or 1 year), limiting their applicability for long-term prognostication. To address these limitations, we first developed ReconSeg3D, a model that reconstructs short-axis cine CMR stacks into temporally-resolved 3D bi-ventricular volumes, capturing fine-grained cardiac anatomy and dynamic motion. These bi-ventricular sequences were then integrated with 45 clinical and CMR-derived variables using spatiotemporal decomposition and cross-attention mechanisms to construct a multimodal MACE prediction model-HeartTTable. HeartTTable achieved a 5-year time-dependent AUC of 0.934 (95% CI 0.907-0.959) and a Harrell's C-index of 0.897 for predicting MACE risk, significantly outperforming models based solely on clinical and CMR-derived tabular features, and demonstrated strong capabilities in postoperative risk stratification. Our study contributes to improved long-term postoperative management for AMI patients by offering clinicians an objective, data-driven decision-support tool.