Rine Nakanishi1, Piotr J Slomka2, Richard Rios3, Julian Betancur3, Michael J Blaha4, Khurram Nasir5, Michael D Miedema6, John A Rumberger7, Heidi Gransar3, Leslee J Shaw8, Alan Rozanski9, Matthew J Budoff10, Daniel S Berman11. 1. Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan; Los Angeles BioMedical Research Institute at Harbor UCLA Medical Center, Torrance, California, USA. 2. Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA; David Geffen School of Medicine at UCLA, Los Angeles, California, USA. Electronic address: piotr.slomka@cshs.org. 3. Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA. 4. Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins Ciccarone Center, Baltimore, Maryland, USA. 5. Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, Florida, USA. 6. Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA. 7. Department of Cardiac Imaging, The Princeton Longevity Center, Princeton, New Jersey, USA. 8. Weill Cornell Medical College, New York, New York, USA. 9. Division of Cardiology, Mount Sinai St. Luke's Hospital, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA. 10. Los Angeles BioMedical Research Institute at Harbor UCLA Medical Center, Torrance, California, USA. 11. Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA; David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Abstract
OBJECTIVES: The aim of this study was to evaluate whether machine learning (ML) of noncontrast computed tomographic (CT) and clinical variables improves the prediction of atherosclerotic cardiovascular disease (ASCVD) and coronary heart disease (CHD) deaths compared with coronary artery calcium (CAC) Agatston scoring and clinical data. BACKGROUND: The CAC score provides a measure of the global burden of coronary atherosclerosis, and its long-term prognostic utility has been consistently shown to have incremental value over clinical risk assessment. However, current approaches fail to integrate all available CT and clinical variables for comprehensive risk assessment. METHODS: The study included data from 66,636 asymptomatic subjects (mean age 54 ± 11 years, 67% men) without established ASCVD undergoing CAC scanning and followed for cardiovascular disease (CVD) and CHD deaths at 10 years. Clinical risk assessment incorporated the ASCVD risk score. For ML, an ensemble boosting approach was used to fit a predictive classifier for outcomes, followed by automated feature selection using information gain ratio. The model-building process incorporated all available clinical and CT data, including the CAC score; the number, volume, and density of CAC plaques; and extracoronary scores; comprising a total of 77 variables. The overall proposed model (ML all) was evaluated using a 10-fold cross-validation framework on the population data and area under the curve (AUC) as metrics. The prediction performance was also compared with 2 traditional scores (ASCVD risk and CAC score) and 2 additional models that were trained using all the clinical data (ML clinical) and CT variables (ML CT). RESULTS: The AUC by ML all (0.845) for predicting CVD death was superior compared with those obtained by ASCVD risk alone (0.821), CAC score alone (0.781), and ML CT alone (0.804) (p < 0.001 for all). Similarly, for predicting CHD death, AUC by ML all (0.860) was superior to the other analyses (0.835 for ASCVD risk, 0.816 for CAC, and 0.827 for ML CT; p < 0.001). CONCLUSIONS: The comprehensive ML model was superior to ASCVD risk, CAC score, and an ML model fitted using CT variables alone in the prediction of both CVD and CHD death.
OBJECTIVES: The aim of this study was to evaluate whether machine learning (ML) of noncontrast computed tomographic (CT) and clinical variables improves the prediction of atherosclerotic cardiovascular disease (ASCVD) and coronary heart disease (CHD) deaths compared with coronary artery calcium (CAC) Agatston scoring and clinical data. BACKGROUND: The CAC score provides a measure of the global burden of coronary atherosclerosis, and its long-term prognostic utility has been consistently shown to have incremental value over clinical risk assessment. However, current approaches fail to integrate all available CT and clinical variables for comprehensive risk assessment. METHODS: The study included data from 66,636 asymptomatic subjects (mean age 54 ± 11 years, 67% men) without established ASCVD undergoing CAC scanning and followed for cardiovascular disease (CVD) and CHD deaths at 10 years. Clinical risk assessment incorporated the ASCVD risk score. For ML, an ensemble boosting approach was used to fit a predictive classifier for outcomes, followed by automated feature selection using information gain ratio. The model-building process incorporated all available clinical and CT data, including the CAC score; the number, volume, and density of CAC plaques; and extracoronary scores; comprising a total of 77 variables. The overall proposed model (ML all) was evaluated using a 10-fold cross-validation framework on the population data and area under the curve (AUC) as metrics. The prediction performance was also compared with 2 traditional scores (ASCVD risk and CAC score) and 2 additional models that were trained using all the clinical data (ML clinical) and CT variables (ML CT). RESULTS: The AUC by ML all (0.845) for predicting CVD death was superior compared with those obtained by ASCVD risk alone (0.821), CAC score alone (0.781), and ML CT alone (0.804) (p < 0.001 for all). Similarly, for predicting CHD death, AUC by ML all (0.860) was superior to the other analyses (0.835 for ASCVD risk, 0.816 for CAC, and 0.827 for ML CT; p < 0.001). CONCLUSIONS: The comprehensive ML model was superior to ASCVD risk, CAC score, and an ML model fitted using CT variables alone in the prediction of both CVD and CHD death.
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