Comparison of machine learning models with conventional statistical methods for prediction of percutaneous coronary intervention outcomes: a systematic review and meta-analysis.

introductionPercutaneous coronary intervention (PCI) has been the main treatment of coronary artery disease (CAD). In this review, we aimed to compare the performance of machine learning (ML) vs. logistic regression (LR) models in predicting different outcomes after PCI.

methodsStudies using ML or deep learning (DL) models to predict mortality, MACE, in-hospital bleeding, and acute kidney injury (AKI) after PCI or primary PCI were included. Articles were excluded if they did not provide a c-statistic, solely used ML models for feature selection, were not in English, or only used logistic or LASSO regression models. Best-performing ML and LR-based models (LR model or conventional risk score) from the same studies were pooled separately to directly compare the performance of ML versus LR. Risk of bias was assessed using the PROBAST and CHARMS checklists.

resultsA total of 59 studies were included. Meta-analysis showed that ML models resulted in a higher c-statistic compared to LR in long-term mortality (0.84 vs. 0.79, P-value = 0.178), short-term mortality (0.91 vs. 0.85, P = 0.149), bleeding (0.81 vs. 0.77 P = 0.261), acute kidney injury (AKI; 0.81 vs. 0.75, P = 0.373), and major adverse cardiac events (MACE; 0.85 vs. 0.75, P = 0.406). PROBAST analysis showed that 93% of long-term mortality, 70% of short-term mortality, 89% of bleeding, 69% of AKI, and 86% of MACE studies had a high risk of bias.

conclusionNo statistical significance existed between ML and LR model. In addition, the high risk of bias in ML studies and complexity in interpretation undermines their validity and may impact their adaption in a clinical settings.