Key result
Models using 12-lead ECG parameters predicted sudden cardiac death with AUCs of 0.68 long-term and up to 0.72 short-term when incorporating ECG changes and clinical data in 17,625 high-risk cardiac patients.
Why the study?
The performance of 12-channel ECG in predicting sudden cardiac death across different time intervals remained to be evaluated.
Does a machine learning model using standard 12-lead ECG parameters accurately predict the short- and long-term risk of sudden cardiac death in high-risk cardiac patients?
Observational (n=17,625)
No
Does a machine learning model using standard 12-lead ECG parameters accurately predict the short- and long-term risk of sudden cardiac death in high-risk cardiac patients?
Machine learning models using standard 12-lead ECG parameters provide only modest predictive value for sudden cardiac death in real-world, high-risk clinical cohorts, performing worse than previously reported in artificial case-control settings.
Modest real-world performance cautions against routine SCD prediction; challenges higher accuracies reported in artificial case-control studies.
We evaluated the performance of 12-channel ECG in predicting sudden cardiac death across different time intervals using a retrospective data set of 17,625 high-risk cardiac patients who underwent coronary angiography (2007–2018) with follow-up data until 2022. Extreme gradient boosting using 12SL Marquette software-derived parameters from digital ECG recording was used to train and validate models using a random 80/20 split. Model performance was evaluated in both unbalanced and risk-factor-balanced case-control sets. Using single ECG, both long-term (from baseline ECG) and short-term predictions (from the last recorded ECG) achieved a modest area under the curve (AUC) of 0.68 in the unbalanced validation and 0.59/0.63 in the balanced validation (long-/short-term). Adding clinical risk factor data resulted in AUC 0.70/0.71 (unbalanced) and 0.64/0.62 (balanced) for long- and short-term prediction. Adding data of observed ECG changes during follow-up for short-term prediction resulted in the best model performance (0.72/0.66; unbalanced/balanced).
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Hernesniemi et al. (2026) conducted an observational in High-risk cardiac patients undergoing coronary angiography for acute coronary syndrome or suspected coronary artery disease (n=17,625). 12-lead ECG with 12SL Marquette software parameters analyzed using machine learning (XGBoost) vs. No ECG-based prediction model (or baseline without added clinical risk factors) was evaluated on Incidence of sudden cardiac death (SCD) or SCD-equivalent events (AUC 0.68 (unbalanced, long-term prediction using baseline ECG)). Models using 12-lead ECG parameters predicted sudden cardiac death with AUCs of 0.68 long-term and up to 0.72 short-term when incorporating ECG changes and clinical data in 17,625 high-risk cardiac patients.
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