Hybrid CNN-Transformer-WOA model with XGBoost-SHAP feature selection for arrhythmia risk prediction in acute myocardial infarction patients

BACKGROUND: Arrhythmia is a frequent and serious complication of acute myocardial infarction (AMI), leading to higher mortality. Early prediction is critical for timely intervention, but existing methods are limited by poor accuracy and low clinical applicability. METHODS: We developed a novel hybrid model integrating convolutional neural network (CNN), Transformer, and Whale Optimization Algorithm (WOA) for arrhythmia prediction in AMI patients. A two-stage feature selection using XGBoost and SHAP identified the top 10 clinical predictors from 45 variables. The model was trained and validated using stratified 10-fold cross-validation on a retrospective cohort of 2,084 patients. Performance was compared with traditional machine learning and deep learning baselines using accuracy, AUC-ROC, F1-score, MCC, and G-Mean. RESULTS: The CNN-Transformer-WOA model achieved an accuracy of 92.4%, an AUC-ROC of 0.96, and an F1-score of 0.91, outperforming all baseline models (p < 0.01). Ablation studies showed that combining CNN and Transformer improved predictive power and that WOA-based hyperparameter tuning further enhanced robustness. The model maintained stable performance across subgroups and demonstrated low inference latency (<8 ms per case). SHAP-based analysis provided interpretable clinical insights. CONCLUSION: This study presents an accurate, interpretable, and robust deep learning solution for arrhythmia prediction in AMI patients. The framework enables real-time, evidence-based risk stratification, and is suitable for integration into clinical decision support systems, offering practical value for improving patient care in real-world hospital environments. CLINICAL TRIAL NUMBER: (No.: ChiCTR2100041960).