After many months of intense collaboration between (in random order): Poltecnico di Torino, University of Turin, Hospital of Turin (Cardiology Department, Italy), S G Bosco Hospital (Italy), Kerckhoff Heart and Thorax Center (Germany), Hospital de Bellvitge,Hospital Álvaro Cunqueiro and Hospital Universitario de Canarias (Spain), Maggiore della Carità Hospital (Italy), Department of Computer Science, University of Turin (Italy), Institute Dalle Molle for Artificial Intelligence (Switzerland), TOELT LLC (Switzerland) the paper

Machine learning-based prediction of adverse events following an acute coronary syndrome (PRAISE): a modelling study of pooled datasets

have been accepted and published on The Lancet! It was a really interesting and stimulating project, also due to the large number of great researchers involved. We were involved in the Machine Learning part, model creation, model discussion and results discussion.

DOI :https://doi.org/10.1016/S0140-6736(20)32519-8

 

Summary

 

Background

The accuracy of current prediction tools for ischaemic and bleeding events after an acute coronary syndrome (ACS) remains insufficient for individualised patient management strategies. We developed a machine learning-based risk stratification model to predict all-cause death, recurrent acute myocardial infarction, and major bleeding after ACS.

Methods

Different machine learning models for the prediction of 1-year post-discharge all-cause death, myocardial infarction, and major bleeding (defined as Bleeding Academic Research Consortium type 3 or 5) were trained on a cohort of 19 826 adult patients with ACS (split into a training cohort [80%] and internal validation cohort [20%]) from the BleeMACS and RENAMI registries, which included patients across several continents. 25 clinical features routinely assessed at discharge were used to inform the models. The best-performing model for each study outcome (the PRAISE score) was tested in an external validation cohort of 3444 patients with ACS pooled from a randomised controlled trial and three prospective registries. Model performance was assessed according to a range of learning metrics including area under the receiver operating characteristic curve (AUC).

Findings

The PRAISE score showed an AUC of 0·82 (95% CI 0·78–0·85) in the internal validation cohort and 0·92 (0·90–0·93) in the external validation cohort for 1-year all-cause death; an AUC of 0·74 (0·70–0·78) in the internal validation cohort and 0·81 (0·76–0·85) in the external validation cohort for 1-year myocardial infarction; and an AUC of 0·70 (0·66–0·75) in the internal validation cohort and 0·86 (0·82–0·89) in the external validation cohort for 1-year major bleeding.

Interpretation

A machine learning-based approach for the identification of predictors of events after an ACS is feasible and effective. The PRAISE score showed accurate discriminative capabilities for the prediction of all-cause death, myocardial infarction, and major bleeding, and might be useful to guide clinical decision making.