Prediction of Fatal Major Adverse Cardiovascular Events After First Acute ST-Segment Elevation Myocardial Infarction Using Clinical, Lifestyle, and Psychosocial Data

Hamid Reza Marateb1, Marjan Mansourian2, Kouhyar Tavakolian3, Hamidreza Roohafza4, Masoumeh Sadeghi4, Miguel Angel Mañanas‬5
1Universitat Politecnica de Catalunya (UPC,BarcelonaTech), 2Epidemiology and Biostatistics Department, School of Health, Isfahan University of Medical Sciences, 3Professor, 4Cardiovascular Research Institute, Isfahan University of Medical Sciences, 5Institute for Research and Innovation in Health (IRIS), Universitat Politècnica de Catalunya-BarcelonaTech (UPC), Spain


Abstract

Fatal cardiovascular events after first acute ST-segment elevation myocardial infarction remain difficult to predict when psychosocial and lifestyle information is omitted. Following the published CRAS-MI methodology and ethics approval IR.NIMAD.REC.1397.295, we analyzed 1,730 modeling records from a multicenter cohort with annual follow-up over 3 years. The endpoint was fatal major adverse cardiovascular events, defined as cardiovascular death from coronary artery or cerebrovascular disease. The dataset contained 79 fatal outcomes (4.6%); mean age was 56.2 +/- 9.9 years, mean body mass index was 26.6 +/- 4.1 kg/m2, and 82.3% were male. A TabNet classifier used clinical, laboratory, lifestyle and psychosocial predictors, derived interaction terms, tuned class weighting, repeated stratified five-fold cross-validation and isotonic calibration. Out-of-fold evaluation yielded AUROC 0.836 (95% CI 0.799-0.877), Brier score 0.037 (0.030-0.044), sensitivity 0.709 (0.612-0.814), and specificity 0.795 (0.776-0.814). Feature importance showed that clinical measures, sleep efficiency and psychosocial variables carried complementary prognostic signal.