Machine-learning-based in-hospital mortality prediction for transcatheter mitral valve repair in the United States
Hernandez-Suarez DF, Ranka S, Kim Y, Latib A, Wiley J, Lopez-Candales A, Pinto DS, Gonzalez MC, Ramakrishna H, Sanina C, Nieves-Rodriguez BG, Rodriguez-Maldonado J, Feliu Maldonado R, Rodriguez-Ruiz IJ, da Luz Sant'Ana I, Wiley KA, Cox-Alomar P, Villablanca PA, and Roche-Lima A. Machine-learning-based in-hospital mortality prediction for transcatheter mitral valve repair in the United States. Cardiovasc Revasc Med 2020.
Cardiovasc Revasc Med
BACKGROUND: Transcatheter mitral valve repair utilization has increased significantly in the United States over the last years. Yet, a risk-prediction tool for adverse events has not been developed. We aimed to generate a machine-learning-based algorithm to predict in-hospital mortality after TMVR.
METHODS: Patients who underwent TMVR from 2012 through 2015 were identified using the National Inpatient Sample database. The study population was randomly divided into a training set (n = 636) and a testing set (n = 213). Prediction models for in-hospital mortality were obtained using five supervised machine-learning classifiers.
RESULTS: A total of 849 TMVRs were analyzed in our study. The overall in-hospital mortality was 3.1%. A naïve Bayes (NB) model had the best discrimination for fifteen variables, with an area under the receiver-operating curve (AUC) of 0.83 (95% CI, 0.80-0.87), compared to 0.77 for logistic regression (95% CI, 0.58-0.95), 0.73 for an artificial neural network (95% CI, 0.55-0.91), and 0.67 for both a random forest and a support-vector machine (95% CI, 0.47-0.87). History of coronary artery disease, of chronic kidney disease, and smoking were the three most significant predictors of in-hospital mortality.
CONCLUSIONS: We developed a robust machine-learning-derived model to predict in-hospital mortality in patients undergoing TMVR. This model is promising for decision-making and deserves further clinical validation.
ePub ahead of print