Predictability of Mortality in Patients With Myocardial Injury After Noncardiac Surgery Based on Perioperative Factors via Machine Learning: Retrospective Study

Abstract

Background Myocardial injury after noncardiac surgery (MINS) is associated with increased postoperative mortality, but the relevant perioperative factors that contribute to the mortality of patients with MINS have not been fully evaluated. Objective To establish a comprehensive body of knowledge relating to patients with MINS, we researched the best performing predictive model based on machine learning algorithms. Methods Using clinical data from 7629 patients with MINS from the clinical data warehouse, we evaluated 8 machine learning algorithms for accuracy, precision, recall, F1 score, area under the receiver operating characteristic (AUROC) curve, and area under the precision-recall curve to investigate the best model for predicting mortality. Feature importance and Shapley Additive Explanations values were analyzed to explain the role of each clinical factor in patients with MINS. Results Extreme gradient boosting outperformed the other models. The model showed an AUROC of 0.923 (95% CI 0.916-0.930). The AUROC of the model did not decrease in the test data set (0.894, 95% CI 0.86-0.922; P=.06). Antiplatelet drugs prescription, elevated C-reactive protein level, and beta blocker prescription were associated with reduced 30-day mortality. Conclusions Predicting the mortality of patients with MINS was shown to be feasible using machine learning. By analyzing the impact of predictors, markers that should be cautiously monitored by clinicians may be identified.