P6421Can cardiologists rely on artificial intelligence to identify the culprit vessel in STEMI?

Abstract

Abstract Background The importance of culprit lesion identification is critical for risk stratification of a patient with an ST-Elevation Myocardial Infarction (STEMI). The aforementioned provide patients with a more elaborated strategy of management and treatment either they are treated with PCI or less invasive techniques such as thrombolysis. We report a novel approach that employs AI-guided electrocardiogram (EKG) algorithms for rapid and accurate identification of the culprit STEMI vessel. Purpose To create an innovative, machine learning tool for a more effective risk stratification of STEMI patients. Methods An observational, retrospective, case-control study. Sample: 2,542 exclusively STEMI diagnosis EKG records that included post discharge feedback from healthcare centers, confirming diagnosis and culprit vessel (Left Main Coronary Artery [LMCA]; Left Anterior Descending [LAD]; Right Coronary Artery [RCA]; Left Circumflex Artery [LCX]; Saphenous Vein Graft [SVG]). Records excluded other patient and medical information. The sample was derived from the private International Telemedical Systems (ITMS) database. LUMENGT-AI Algorithm was employed. Preprocessing: detection of QRS complexes using a wavelet system, segmentation of each EKG into individual heartbeats (27,125 total beats) with fixed window of 0.4s to the left and 0.9s to the right of main QRS; Classification: A 1-D convolutional neural network was implemented; “LCMA”, “LAD”, “LCX”, “RCA”, “SVG”, and “No Information” classes were considered for each heartbeat; individual probabilities were aggregated to generate the final label for each record. Training & Testing: 90% and 10% of the sample was used, respectively. Experiments: Intel PC i7 8750H processor at 2.21GHz, 16GB RAM, Windows 10 OS with NVidia GTX 1070 GPU, 8GB RAM. Results Global Accuracy: 79.4%; LAD: Sensitivity 86.2%; Specificity 84.8%. RCA: Sensitivity 85.7%; Specificity 83.7%. LCX: Sensitivity 43.5%; Specificity 96.9%. Conclusions Coupling an AI-augmented algorithm and 12-lead EKG provides encouraging results for STEMI culprit vessel localization. Overall, risk stratification is possible for individual lesions located in the LAD and RCA. However, our approach yielded uncertain results in the LCX territory. We plan to continue to exploring variables for improvement of our results.