Machine learning-based prediction of mortality in acute myocardial infarction with cardiogenic shock

Background In the ICU, patients with acute myocardial infarction and cardiogenic shock (AMI-CS) often face high mortality rates, making timely and precise mortality risk prediction crucial for clinical decision-making. Despite existing models, machine learning algorithms hold the potential for improved predictive accuracy.Methods In this study, a predictive model was developed using the MIMIC-IV database, with external validation performed on the eICU-CRD database. We included ICU patients diagnosed with AMI-CS. Feature selection was conducted using the Boruta algorithm, followed by the construction and comparison of four machine learning models: Logistic Regression (LR), eXtreme Gradient Boosting (XGBoost), Adaptive Boosting (AdaBoost), and Gaussian Naive Bayes (GNB). Model performance was evaluated based on metrics such as AUC (Area Under the Curve), accuracy, sensitivity, specificity, and so on. The SHAP method was employed to visualize and interpret the importance of model features. Finally, we constructed an online prediction model and conducted external validation in the eICU-CRD database.Results In this study, a total of 570 and 391 patients with AMI-CS were included from the MIMIC-IV and eICU-CRD databases, respectively. Among all machine learning algorithms evaluated, LR exhibited the best performance with a validation set AUC of 0.841(XGBoost: 0.835, AdaBoost: 0.839, GNB: 0.826). The model incorporated five variables: prothrombin time, blood urea nitrogen, age, beta-blockers and Angiotensin-Converting Enzyme Inhibitors or Angiotensin II Receptor Blockers. SHAP plots are employed to visualize the importance of model features and to interpret the results. An online prediction tool was developed, externally validated with the eICU-CRD database, achieving an AUC of 0.755.Conclusion Employing the LR algorithm, we developed a predictive model for assessing the mortality risk among AMI-CS patients in the ICU setting. Through model predictions, this facilitates early detection of high-risk individuals, ensures judicious allocation of healthcare resources.