Early Risk Assessment Model for ICA Timing Strategy in Unstable Angina Patients Using Multi-Modal Machine Learning

Background: Invasive coronary arteriography (ICA) is recognized as the gold standard for diagnosing cardiovascular diseases, including unstable angina (UA). The challenge lies in determining the optimal timing for ICA in UA patients, balancing the need for revascularization in high-risk patients against the potential complications in low-risk ones. Unlike myocardial infarction, UA does not have specific indicators like ST-segment deviation or cardiac enzymes, making risk assessment complex. Objectives: Our study aims to enhance the early risk assessment for UA patients by utilizing machine learning algorithms. These algorithms can potentially identify patients who would benefit most from ICA by analyzing less specific yet related indicators that are challenging for human physicians to interpret. Methods: We collected data from 640 UA patients at Shanghai General Hospital, including medical history and electrocardiograms (ECG). Machine learning algorithms were trained using multi-modal demographic characteristics including clinical risk factors, symptoms, biomarker levels, and ECG features extracted by pre-trained neural networks. The goal was to stratify patients based on their revascularization risk. Additionally, we translated our models into applicable and explainable look-up tables through discretization for practical clinical use. Results: The study achieved an Area Under the Curve (AUC) of $0.719 \pm 0.065$ in risk stratification, significantly surpassing the widely adopted GRACE score's AUC of $0.579 \pm 0.044$. Conclusions: The results suggest that machine learning can provide superior risk stratification for UA patients. This improved stratification could help in balancing the risks, costs, and complications associated with ICA, indicating a potential shift in clinical assessment practices for unstable angina.