title: Machine learning for prediction of all-cause mortality in patients with suspected coronary artery disease: a 5-year multicentre prospective registry analysis.
abstract: OBJECTIVE
  Traditional prognostic risk assessment in patients undergoing non-invasive imaging is based upon a limited selection of clinical and imaging findings. Machine learning (ML) can consider a greater number and complexity of variables. Therefore, we investigated the feasibility and accuracy of ML to predict 5-year all-cause mortality (ACM) in patients undergoing coronary computed tomographic angiography (CCTA), and compared the performance to existing clinical or CCTA metrics.
  
  
  RESULTS
  The analysis included 10 030 patients with suspected coronary artery disease and 5-year follow-up from the COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter registry. All patients underwent CCTA as their standard of care. Twenty-five clinical and 44 CCTA parameters were evaluated, including segment stenosis score (SSS), segment involvement score (SIS), modified Duke index (DI), number of segments with non-calcified, mixed or calcified plaques, age, sex, gender, standard cardiovascular risk factors, and Framingham risk score (FRS). Machine learning involved automated feature selection by information gain ranking, model building with a boosted ensemble algorithm, and 10-fold stratified cross-validation. Seven hundred and forty-five patients died during 5-year follow-up. Machine learning exhibited a higher area-under-curve compared with the FRS or CCTA severity scores alone (SSS, SIS, DI) for predicting all-cause mortality (ML: 0.79 vs. FRS: 0.61, SSS: 0.64, SIS: 0.64, DI: 0.62; P< 0.001).
  
  
  CONCLUSIONS
  Machine learning combining clinical and CCTA data was found to predict 5-year ACM significantly better than existing clinical or CCTA metrics alone.
authors.affiliation: Departments of Imaging and Medicine and the Cedars-Sinai Heart Institute, and the Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Manish
authors.initials: M
authors.lastname: Motwani
authors.affiliation: Departments of Imaging and Medicine and the Cedars-Sinai Heart Institute, and the Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Damini
authors.initials: D
authors.lastname: Dey
authors.affiliation: Departments of Imaging and Medicine and the Cedars-Sinai Heart Institute, and the Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
authors.affiliation: Departments of Imaging and Medicine and the Cedars-Sinai Heart Institute, and the Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Guido
authors.initials: G
authors.lastname: Germano
authors.affiliation: Department of Cardiology, Friedrich Alexander Universität Erlangen-Nürnberg, Germany.
authors.forename: Stephan
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authors.lastname: Achenbach
authors.affiliation: King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King AbdulAziz Cardiac Center Saudia Arabia.
authors.forename: Mouaz H
authors.initials: MH
authors.lastname: Al-Mallah
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Andreini
authors.affiliation: Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
authors.affiliation: Department of Radiology, Montréal Heart Institute/Université de Montréal, Montréal, Quebec, Canada.|Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Filippo
authors.initials: F
authors.lastname: Cademartiri
authors.affiliation: Tennessee Heart and Vascular Institute, Hendersonville, TN, USA.
authors.forename: Tracy Q
authors.initials: TQ
authors.lastname: Callister
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Seoul, South Korea.
authors.forename: Hyuk-Jae
authors.initials: HJ
authors.lastname: Chang
authors.affiliation: William Beaumont Hospital, Royal Oaks, MI, USA.
authors.forename: Kavitha
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authors.lastname: Chinnaiyan
authors.affiliation: Department of Medicine and Radiology, University of Ottawa Heart Institute, ON, Canada.
authors.forename: Benjamin J W
authors.initials: BJ
authors.lastname: Chow
authors.affiliation: Miami Cardiac and Vascular Institute, Miami, FL, USA.
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authors.initials: RC
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authors.affiliation: Capitol Cardiology Associates, Albany, NY, USA.
authors.forename: Augustin
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authors.lastname: Delago
authors.affiliation: Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York-Presbyterian Hospital, New York, NY, USA.
authors.forename: Millie
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authors.lastname: Gomez
authors.affiliation: Departments of Imaging and Medicine and the Cedars-Sinai Heart Institute, and the Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Heidi
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authors.lastname: Gransar
authors.affiliation: Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany.
authors.forename: Martin
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authors.lastname: Hadamitzky
authors.affiliation: Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany.
authors.forename: Joerg
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authors.lastname: Hausleiter
authors.affiliation: Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York-Presbyterian Hospital, New York, NY, USA.
authors.forename: Niree
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authors.lastname: Hindoyan
authors.affiliation: Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Gudrun
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authors.lastname: Feuchtner
authors.affiliation: Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Philipp A
authors.initials: PA
authors.lastname: Kaufmann
authors.affiliation: Department of Medicine and Radiology, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Yong-Jin
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Medical Imaging and Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Jonathon
authors.initials: J
authors.lastname: Leipsic
authors.affiliation: Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York-Presbyterian Hospital, New York, NY, USA.
authors.forename: Fay Y
authors.initials: FY
authors.lastname: Lin
authors.affiliation: Montréal Heart Institute, Montréal, Quebec, Canada.
authors.forename: Erica
authors.initials: E
authors.lastname: Maffei
authors.affiliation: Department of Radiology, UNICA - Hospital da LUZ, Lisbon, Portugal.
authors.forename: Hugo
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authors.lastname: Marques
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Gianluca
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authors.lastname: Pontone
authors.affiliation: William Beaumont Hospital, Royal Oaks, MI, USA.
authors.forename: Gilbert
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authors.lastname: Raff
authors.affiliation: Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Ronen
authors.initials: R
authors.lastname: Rubinshtein
authors.affiliation: Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Leslee J
authors.initials: LJ
authors.lastname: Shaw
authors.affiliation: Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Julia
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authors.lastname: Stehli
authors.affiliation: Department of Medicine, Walter Reed National Medical Center, Bethesda, MD, USA.
authors.forename: Todd C
authors.initials: TC
authors.lastname: Villines
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Dunning
authors.affiliation: Departments of Radiology and Medicine, Weill Cornell Medical College, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital, New York, NY, USA.
authors.forename: James K
authors.initials: JK
authors.lastname: Min
authors.affiliation: Departments of Imaging and Medicine and the Cedars-Sinai Heart Institute, and the Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Piotr J
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mesh_terms: D002423:Cause of Death; D000072226:Computed Tomography Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D000069550:Machine Learning; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors
keywords: Coronary CT angiography; Coronary artery disease; Machine learning; Prognosis