In-hospital risk stratification algorithm of Asian elderly patients

• Published in: Scientific Reports
• Main Author: Kasim S.; Malek S.; Cheen S.; Safiruz M.S.; Ahmad W.A.W.; Ibrahim K.S.; Aziz F.; Negishi K.; Ibrahim N.
• Format: Article
• Language: English
• Published: Nature Research 2022
• Online Access: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85140266055&doi=10.1038%2fs41598-022-18839-9&partnerID=40&md5=3a0dff4e7394f2c14caebed892c3e153

Limited research has been conducted in Asian elderly patients (aged 65 years and above) for in-hospital mortality prediction after an ST-segment elevation myocardial infarction (STEMI) using Deep Learning (DL) and Machine Learning (ML). We used DL and ML to predict in-hospital mortality in Asian elderly STEMI patients and compared it to a conventional risk score for myocardial infraction outcomes. Malaysia's National Cardiovascular Disease Registry comprises an ethnically diverse Asian elderly population (3991 patients). 50 variables helped in establishing the in-hospital death prediction model. The TIMI score was used to predict mortality using DL and feature selection methods from ML algorithms. The main performance metric was the area under the receiver operating characteristic curve (AUC). The DL and ML model constructed using ML feature selection outperforms the conventional risk scoring score, TIMI (AUC 0.75). DL built from ML features (AUC ranging from 0.93 to 0.95) outscored DL built from all features (AUC 0.93). The TIMI score underestimates mortality in the elderly. TIMI predicts 18.4% higher mortality than the DL algorithm (44.7%). All ML feature selection algorithms identify age, fasting blood glucose, heart rate, Killip class, oral hypoglycemic agent, systolic blood pressure, and total cholesterol as common predictors of mortality in the elderly. In a multi-ethnic population, DL outperformed the TIMI risk score in classifying elderly STEMI patients. ML improves death prediction by identifying separate characteristics in older Asian populations. Continuous testing and validation will improve future risk classification, management, and results. © 2022, The Author(s).