Abstract
BACKGROUND: Previous studies have used machine leaning to predict clinical deterioration to improve outcome prediction. However, no study has used machine learning to predict cardiac arrest in patients with acute coronary syndrome (ACS). Algorithms are required to generate high-performance models for predicting cardiac arrest in ACS patients with multivariate features. HYPOTHESIS: Machine learning algorithms will significantly improve outcome prediction of cardiac arrest in ACS patients. METHODS: This retrospective cohort study reviewed 166 ACS patients who had in-hospital cardiac arrest. Eight machine learning algorithms were trained using multivariate clinical features obtained 24 h prior to the onset of cardiac arrest. All machine learning models were compared to each other and to existing risk prediction scores (Global Registry of Acute Coronary Events, National Early Warning Score, and Modified Early Warning Score) using the area under the receiver operating characteristic curve (AUROC). RESULTS: The XGBoost model provided the best performance with regard to AUC (0.958 [95%CI: 0.938-0.978]), accuracy (88.9%), sensitivity (73%), negative predictive value (89%), and F1 score (80%) compared with other machine learning models. The K-nearest neighbor model generated the best specificity (99.3%) and positive predictive value (93.8%) metrics, but had low and unacceptable values for sensitivity and AUC. Most, but not all, machine learning models outperformed the existing risk prediction scores. CONCLUSIONS: The XGBoost model, which was generated based on a machine learning algorithm, has high potential to be used to predict cardiac arrest in ACS patients. This proposed model significantly improves outcome prediction compared to existing risk prediction scores.