Risk stratification of patients who present with chest pain and have normal troponins using a machine learning model  

作　　者：Muhammad Shafiq Diego Robles Mazzotti Cheryl Gibson 

机构地区：[1]Division of General and Geriatric Medicine,Department of Internal Medicine,University of Kansas Medical Center,Kansas City,KS 66160,United States [2]Division of Medical Informatics&Division of Pulmonary Critical Care and Sleep Medicine,Department of Internal Medicine,University of Kansas Medical Center,Kansas City,KS 66160,United States

出　　处：《World Journal of Cardiology》2022年第11期565-575,共11页世界心脏病学杂志（英文版）（电子版）

基　　金：supported by the Clinical and Translational Science Award from the National Center for Advancing Translational Sciences,which has been awarded to the University of Kansas Clinical and Translational Science Institute.

摘　　要：BACKGROUND Risk stratification tools exist for patients presenting with chest pain to the emergency room and have achieved the recommended negative predictive value(NPV)of 99%.However,due to low positive predictive value(PPV),current stratification tools result in unwarranted investigations such as serial laboratory tests and cardiac stress tests(CSTs).AIM To create a machine learning model(MLM)for risk stratification of chest pain with a better PPV.METHODS This retrospective cohort study used de-identified hospital data from January 2016 until November 2021.Inclusion criteria were patients aged>21 years who presented to the ER,had at least two serum troponins measured,were subsequently admitted to the hospital,and had a CST within 4 d of presentation.Exclusion criteria were elevated troponin value(>0.05 ng/mL)and missing values for body mass index.The primary outcome was abnormal CST.Demographics,coronary artery disease(CAD)history,hypertension,hyperlipidemia,diabetes mellitus,chronic kidney disease,obesity,and smoking were evaluated as potential risk factors for abnormal CST.Patients were also categorized into a high-risk group(CAD history or more than two risk factors)and a low-risk group(all other patients)for comparison.Bivariate analysis was performed using a χ^(2) test or Fisher’s exact test.Age was compared by t test.Binomial regression(BR),random forest,and XGBoost MLMs were used for prediction.Bootstrapping was used for the internal validation of prediction models.BR was also used for inference.Alpha criterion was set at 0.05 for all statistical tests.R software was used for statistical analysis.RESULTS The final cohort of the study included 2328 patients,of which 245(10.52%)patients had abnormal CST.When adjusted for covariates in the BR model,male sex[risk ratio(RR)=1.52,95%confidence interval(CI):1.2-1.94,P<0.001],CAD history(RR=4.46,95%CI:3.08-6.72,P<0.001),and hyperlipidemia(RR=3.87,95%CI:2.12-8.12,P<0.001)remained statistically significant.Incidence of abnormal CST was 12.2%in the high-risk gro

关 键 词：Machine learning Chest pain Risk stratification Risk factors Cardiac stress test Cardiac catheterization 

分 类 号：R54[医药卫生—心血管疾病] TP181[医药卫生—内科学]