Open AccessMachine Learning Framework to Identify Individuals at Risk of Rapid Progression of Coronary Atherosclerosis: From the PARADIGM Registry
Author(s) -
Han Donghee,
Kolli Kranthi K.,
Al'Aref Subhi J.,
Baskaran Lohendran,
Rosendael Alexander R.,
Gransar Heidi,
Andreini Daniele,
Budoff Matthew J.,
Cademartiri Filippo,
Chinnaiyan Kavitha,
Choi Jung Hyun,
Conte Edoardo,
Marques Hugo,
Araújo Gonçalves Pedro,
Gottlieb Ilan,
Hadamitzky Martin,
Leipsic Jonathon A.,
Maffei Erica,
Pontone Gianluca,
Raff Gilbert L.,
Shin Sangshoon,
Kim YongJin,
Lee Byoung Kwon,
Chun Eun Ju,
Sung Ji Min,
Lee SangEun,
Virmani Renu,
Samady Habib,
Stone Peter,
Narula Jagat,
Berman Daniel S.,
Bax Jeroen J.,
Shaw Leslee J.,
Lin Fay Y.,
Min James K.,
Chang HyukJae
Publication year - 2020
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.119.013958
Subject(s) - medicine , coronary artery disease , atheroma , framingham risk score , computed tomography angiography , angiography , logistic regression , receiver operating characteristic , coronary atherosclerosis , radiology , cardiology , disease
Background Rapid coronary plaque progression (RPP) is associated with incident cardiovascular events. To date, no method exists for the identification of individuals at risk of RPP at a single point in time. This study integrated coronary computed tomography angiography–determined qualitative and quantitative plaque features within a machine learning (ML) framework to determine its performance for predicting RPP. Methods and Results Qualitative and quantitative coronary computed tomography angiography plaque characterization was performed in 1083 patients who underwent serial coronary computed tomography angiography from the PARADIGM (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging) registry. RPP was defined as an annual progression of percentage atheroma volume ≥1.0%. We employed the following ML models: model 1, clinical variables; model 2, model 1 plus qualitative plaque features; model 3, model 2 plus quantitative plaque features. ML models were compared with the atherosclerotic cardiovascular disease risk score, Duke coronary artery disease score, and a logistic regression statistical model. 224 patients (21%) were identified as RPP. Feature selection in ML identifies that quantitative computed tomography variables were higher‐ranking features, followed by qualitative computed tomography variables and clinical/laboratory variables. ML model 3 exhibited the highest discriminatory performance to identify individuals who would experience RPP when compared with atherosclerotic cardiovascular disease risk score, the other ML models, and the statistical model (area under the receiver operating characteristic curve in ML model 3, 0.83 [95% CI 0.78–0.89], versus atherosclerotic cardiovascular disease risk score, 0.60 [0.52–0.67]; Duke coronary artery disease score, 0.74 [0.68–0.79]; ML model 1, 0.62 [0.55–0.69]; ML model 2, 0.73 [0.67–0.80]; all P <0.001; statistical model, 0.81 [0.75–0.87], P =0.128). Conclusions Based on a ML framework, quantitative atherosclerosis characterization has been shown to be the most important feature when compared with clinical, laboratory, and qualitative measures in identifying patients at risk of RPP.