Predicting the risk of heart failure after acute myocardial infarction using an interpretable machine learning model

Background Early prediction of heart failure (HF) after acute myocardial infarction (AMI) is essential for personalized treatment. We aimed to use interpretable machine learning (ML) methods to develop a risk prediction model for HF in AMI patients.Methods We retrospectively included patients initially with AMI who received percutaneous coronary intervention (PCI) in our hospital from November 2016 to February 2020. The primary endpoint was the occurrence of HF within 3 years after operation. For developing a predictive model for HF risk in AMI patients, the least absolute shrinkage and selection operator (LASSO) Regression was used to feature selection, and four ML algorithms including Random Forest (RF), Extreme Gradient Boost (XGBoost), Support Vector Machine (SVM), and Logistic Regression (LR) were employed to develop the model on the training set. The performance evaluation of the prediction model was carried out on the training set and the testing set, utilizing metrics including AUC (Area under the receiver operating characteristic curve), calibration plot, and decision curve analysis (DCA). In addition, we used the Shapley Additive Explanations (SHAP) value to determine the importance of the selected features and interpret the optimal model.Results A total of 1220 AMI patients were included and 244 (20%) patients developed HF during follow-up. Among the four evaluated ML models, the XGBoost model exhibited exceptional accuracy, with an AUC value of 0.922. The SHAP method showed that left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVDs) and lactate dehydrogenase (LDH) were identified as the three most important characteristics to predict HF risk in AMI patients. Individual risk assessment was performed using SHAP plots and waterfall plot analysis.Conclusions Our research demonstrates the potential of ML methods in the early prediction of HF risk in AMI patients. Furthermore, it enhances the interpretability of the XGBoost model through SHAP analysis to guide clinical decision-making.