Risk stratification of ST-segment elevation myocardial infarction (STEMI) patients using machine learning based on lipid profiles

Lipids in Health and Disease

Jian Shen¹  Zhenxian Xiang¹  Yuzhou Xue¹  Yuansong Zhu¹  Suxin Luo¹  Wei Zhou¹  Weifeng Hong²  Chuiguo Huang³ 

[1] Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, NO.1 Youyi Road, Yuzhong District, 400016, Chongqing, China;Department of Medical Imaging, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China;Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China;

关键词: Machine learning;    Lipoprotein;    ST-segment elevation myocardial infarction;    Prognosis;    Cardiovascular statin-modified risk;   

DOI  :  10.1186/s12944-021-01475-z

来源: Springer

【 摘 要 】

BackgroundNumerous studies have revealed the relationship between lipid expression and increased cardiovascular risk in ST-segment elevation myocardial infarction (STEMI) patients. Nevertheless, few investigations have focused on the risk stratification of STEMI patients using machine learning algorithms.MethodsA total of 1355 STEMI patients who underwent percutaneous coronary intervention were enrolled in this study during 2015–2018. Unsupervised machine learning (consensus clustering) was applied to the present cohort to classify patients into different lipid expression phenogroups, without the guidance of clinical outcomes. Kaplan-Meier curves were implemented to show prognosis during a 904-day median follow-up (interquartile range: 587–1316). In the adjusted Cox model, the association of cluster membership with all adverse events including all-cause mortality, all-cause rehospitalization, and cardiac rehospitalization was evaluated.ResultsAll patients were classified into three phenogroups, 1, 2, and 3. Patients in phenogroup 1 with the highest Lp(a) and the lowest HDL-C and apoA1 were recognized as the statin-modified cardiovascular risk group. Patients in phenogroup 2 had the highest HDL-C and apoA1 and the lowest TG, TC, LDL-C and apoB. Conversely, patients in phenogroup 3 had the highest TG, TC, LDL-C and apoB and the lowest Lp(a). Additionally, phenogroup 1 had the worst prognosis. Furthermore, a multivariate Cox analysis revealed that patients in phenogroup 1 were at significantly higher risk for all adverse outcomes.ConclusionMachine learning-based cluster analysis indicated that STEMI patients with increased concentrations of Lp(a) and decreased concentrations of HDL-C and apoA1 are likely to have adverse clinical outcomes due to statin-modified cardiovascular risks.Trial registrationChiCTR1900028516 (http://www.chictr.org.cn/index.aspx).

【 授权许可】

CC BY