An artificial intelligence approach to early predict non-ST-elevation myocardial infarction patients with chest pain

BACKGROUND AND AIMS Hospital admission rate for the patients with chest pain has already been increased worldwide but no existing risk score has been designed to stratify non-ST-elevation myocardial infarction (NSTEMI) from non-cardiogenic chest pain. Clinical diagnosis of chest pain in the emergency department is always highly subjective and variable. We, therefore, aimed to develop an artificial intelligence approach to predict stable NSTEMI that would give valuable insight to reduce misdiagnosis in the real clinical setting. METHODS A standard protocol was developed to collect data from chest pain patients who had visited the emergency department between December 2016 and February 2017. All the chest pain patients with aged <20 years were primarily included in this study. However, STEMI, previous history of ACS, and out-of-hospital cardiac arrest were excluded from our study. An artificial neural network (ANN) model was then developed to predict NSTEMI patients. The accuracy, sensitivity, specificity, and receiver operating characteristic curve was used to measure the performance of this model. RESULTS A total of 268 chest pain patients were included in this study; of those, 47 (17.5%) was stable NSTEMI, and 221 (82.5%) was unstable angina patients. Serval risk factors such as cardiac risk factor, systolic blood pressure, hemoglobin, corrected QT interval (QTc), PR interval, glutamic-oxaloacetic transaminase, glutamic pyruvic transaminase and troponin were independently associated with stable NSTEMI. The area under the receiver operating characteristic (AUROC) and accuracy of ANN were 98.4, and 92.86. Additionally, the sensitivity, specificity, positive predictive value, and negative predictive value of the ANN model was 90.91, 93.33, 76.92, and 97.67 respectively. CONCLUSION Our prediction model showed a higher accuracy to predict NSTEMI patients. This model has a potential application in disease detection, monitoring, and prognosis of chest pain at risk of AMI.

[1]  Manoj Kumar,et al.  Correlation of corrected QT interval with quantitative cardiac troponin-I levels and its prognostic role in Non-ST-elevation myocardial infarction. , 2017, International journal of cardiology.

[2]  Leong L Ng,et al.  C-terminal provasopressin (copeptin) as a prognostic marker after acute non-ST elevation myocardial infarction: Leicester Acute Myocardial Infarction Peptide II (LAMP II) study. , 2011, Clinical science.

[3]  Rui Liu,et al.  Comparison of the Effects of Ticagrelor and Clopidogrel on Inflammatory Factors, Vascular Endothelium Functions and Short-Term Prognosis in Patients with Acute ST-Segment Elevation Myocardial Infarction Undergoing Emergency Percutaneous Coronary Intervention: a Pilot Study , 2018, Cellular Physiology and Biochemistry.

[4]  Andrew E. Arai,et al.  Detecting patients with acute coronary syndrome in the chest pain center of the emergency department with cardiac magnetic resonance imaging. , 2004, Critical pathways in cardiology.

[5]  Carl J Pepine,et al.  ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction--summary article: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee on the Management of Patients , 2002, Journal of the American College of Cardiology.

[6]  Joseph P Ornato,et al.  Implication of different cardiac troponin I levels for clinical outcomes and prognosis of acute chest pain patients. , 2004, Journal of the American College of Cardiology.

[7]  Pedro de Araújo Gonçalves,et al.  TIMI, PURSUIT, and GRACE risk scores: sustained prognostic value and interaction with revascularization in NSTE-ACS. , 2005 .

[8]  Tahir Mehmood,et al.  Acute coronary syndrome risk prediction of rapid emergency medicine scoring system in acute chest pain , 2017, Saudi Medical Journal.

[9]  E. Peterson,et al.  Comparison of the Prognostic Value of Peak Creatine Kinase‐MB and Troponin Levels Among Patients With Acute Myocardial Infarction: A Report from the Acute Coronary Treatment and Intervention Outcomes Network Registry–Get With The Guidelines , 2012, Clinical cardiology.

[10]  Salim Yusuf,et al.  The relationships of left ventricular ejection fraction, end-systolic volume index and infarct size to six-month mortality after hospital discharge following myocardial infarction treated by thrombolysis. , 2002, Journal of the American College of Cardiology.

[11]  Robert Woolard,et al.  Missed Diagnoses of Acute Cardiac Ischemia in the Emergency Department , 2000 .

[12]  Melissa A Daubert,et al.  The utility of troponin measurement to detect myocardial infarction: review of the current findings , 2010, Vascular health and risk management.

[13]  Chung H. Liu,et al.  Comparison of STEMI and NSTEMI patients in the emergency department , 2011 .

[14]  R. Hsia,et al.  A National Study of the Prevalence of Life-Threatening Diagnoses in Patients With Chest Pain. , 2016, JAMA internal medicine.

[15]  J. Gore,et al.  Creatinine clearance and adverse hospital outcomes in patients with acute coronary syndromes: findings from the global registry of acute coronary events (GRACE) , 2003, Heart.

[16]  Olle Pahlm,et al.  ST-segment deviation analysis of the admission 12-lead electrocardiogram as an aid to early diagnosis of acute myocardial infarction with a cardiac magnetic resonance imaging gold standard. , 2007, Journal of the American College of Cardiology.

[17]  Stefan Blankenberg,et al.  Sensitive troponin I assay in early diagnosis of acute myocardial infarction. , 2009, The New England journal of medicine.

[18]  Mark D. Huffman,et al.  AHA Statistical Update Heart Disease and Stroke Statistics — 2012 Update A Report From the American Heart Association WRITING GROUP MEMBERS , 2010 .

[19]  William Wijns,et al.  [Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes]. , 2007, Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology.

[20]  Nan Liu,et al.  Comparing HEART, TIMI, and GRACE scores for prediction of 30-day major adverse cardiac events in high acuity chest pain patients in the emergency department. , 2016, International journal of cardiology.

[21]  Mohamed Loutfi,et al.  Identification of High-Risk Patients with Non-ST Segment Elevation Myocardial Infarction using Strain Doppler Echocardiography: Correlation with Cardiac Magnetic Resonance Imaging , 2016, Clinical Medicine Insights. Cardiology.

[22]  Angelo Branzi,et al.  Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: the task force for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes of the European Society of Cardiology. , 2007, European heart journal.

[23]  Alba Lucia Bottura Leite de Barros,et al.  Association of cardiovascular risk factors with the different presentations of acute coronary syndrome1 , 2014, Revista latino-americana de enfermagem.