Machine learning models demonstrated high diagnostic accuracy for predicting outcomes post-percutaneous coronary intervention, though significant challenges regarding missing data and external validation remain.
Systematic Review (n=4,943,425)
Does machine learning improve the prediction of clinical outcomes in patients who have undergone percutaneous coronary intervention?
Machine learning models show promise as clinical adjuncts to traditional risk scores for predicting post-PCI outcomes, but require better validation and handling of missing data before clinical integration.
Background: Recent studies have shown potential in introducing machine learning (ML) algorithms to predict outcomes post-percutaneous coronary intervention (PCI). Aims:We aimed to critically appraise current ML models' effectiveness as clinical tools to predict outcomes post-PCI.Methods: Searches of four databases were conducted for articles published from the database inception date to 29 May 2021.Studies using ML to predict outcomes post-PCI were included.For individual post-PCI outcomes, measures of diagnostic accuracy were extracted.An adapted checklist comprising existing frameworks for new risk markers, diagnostic accuracy, prognostic tools and ML was used to critically appraise the included studies along the stages of the translational pathway: development, validation, and impact.Quality of training data and methods of dealing with missing data were evaluated.Results: Twelve cohorts from 11 studies were included with a total of 4,943,425 patients.ML models performed with high diagnostic accuracy.However, there are concerns over the development of the ML models.Methods of dealing with missing data were problematic.Four studies did not discuss how missing data were handled.One study removed patients if any of the predictor variable data points were missing.Moreover, at the validation stage, only three studies externally validated the models presented.There could be concerns over the applicability of these models.None of the studies discussed the cost-effectiveness of implementing the models.Conclusions: ML models show promise as a useful clinical adjunct to traditional risk stratification scores in predicting outcomes post-PCI.However, significant challenges need to be addressed before ML can be integrated into clinical practice.
Wee et al. (Sun,) conducted a systematic review in Post-percutaneous coronary intervention (PCI) (n=4,943,425). Machine learning models vs. Traditional risk stratification tools and statistical modelling was evaluated on Diagnostic accuracy (AUC, sensitivity, specificity, PPV, NPV) for post-PCI outcomes. Machine learning models demonstrated high diagnostic accuracy for predicting outcomes post-percutaneous coronary intervention, though significant challenges regarding missing data and external validation remain.