Abstract
BACKGROUND: Preventing in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) is a crucial step. OBJECTIVES: The objective of our research was to develop and externally validate the diagnostic model of in-hospital mortality in acute STEMI patients used artificial intelligence methods. METHODS: We divided nonrandomly the American population with acute STEMI into a training set, a test set, and a validation set. We converted the unbalanced data into balanced data. We used artificial intelligence methods to develop and externally validate several diagnostic models. We used confusion matrix combined with the area under the receiver operating characteristic curve (AUC) to evaluate the pros and cons of the above models. RESULTS: The strongest predictors of in-hospital mortality were age, gender, cardiogenic shock, atrial fibrillation (AF), ventricular fibrillation (VF), third degree atrioventricular block, in-hospital bleeding, underwent percutaneous coronary intervention (PCI) during hospitalization, underwent coronary artery bypass grafting (CABG) during hospitalization, hypertension history, diabetes history, and myocardial infarction history. The F2 score of logistic regression in the training set, the test set, and the validation dataset was 0.81, 0.6, and 0.59, respectively. The AUC of logistic regression in the training set, the test set, and the validation data set was 0.77, 0.78, and 0.8, respectively. The diagnostic model built by logistic regression was the best. CONCLUSION: The strongest predictors of in-hospital mortality were age, gender, cardiogenic shock, AF, VF, third degree atrioventricular block, in-hospital bleeding, underwent PCI during hospitalization, underwent CABG during hospitalization, hypertension history, diabetes history, and myocardial infarction history. We had used artificial intelligence methods developed and externally validated several diagnostic models of in-hospital mortality in acute STEMI patients. The diagnostic model built by logistic regression was the best. We registered this study with the registration number ChiCTR1900027129 (the WHO International Clinical Trials Registry Platform (ICTRP) on 1 November 2019).