Sadasivuni, Sudarsan

Abstract Background. Clinical medicine relies heavily on the synthesis of information and data from multiple sources. However, often simple feature concatenation is used as a strategy for developing a multimodal machine learning model in the cardiovascular domain, and thus the models are often limited by pre-selected features and moderate accuracy. Method. We proposed a two-branched joint fusion model for fusing the 12-lead electrocardiogram (ECG) signal data with clinical variables from the electronic medical record (EMR) in an end-to-end deep learning architecture. The model follows the joint fusion scheme and learns complementary information from ECG and EMR. Retrospective data from the Mayo Clinic Health Systems across four sites for patients that underwent percutaneous coronary intervention (PCI) were obtained. Model performance was assessed by area under the receiver-operating characteristics (AUROC) and Delong’s test. Results. The final cohort included 17,356 unique patients with a mean age of 67.2 ± 12.6 year (mean ± std) and 9,163 (52.7%) were male. The joint fusion model outperformed the ECG time-domain model with statistical margin. The model with clinical data obtained the highest AUROC for all-cause mortality (0.91 at 6 months) but the joint fusion model outperformed for cardiovascular outcomes - heart failure hospitalization and ischemic stroke with a significant margin (Delong’s p < 0.05). Conclusion. To the best of our knowledge, this is the first study that developed a deep learning model with joint fusion architecture for the prediction of post-PCI prognosis and outperformed machine learning models developed using traditional single-source features (clinical variables or ECG features). Adding ECG data with clinical variables did not improve prediction of all-cause mortality as may be expected, but the improved performance of related cardiac outcomes shows that the fusion of ECG generates additional value.