Electrocardiography-Based Artificial Intelligence Algorithm Aids in Prediction of Long-term Mortality After Cardiac Surgery

Abdulah A. Mahayni, Zachi I. Attia, Jose R. Medina-Inojosa, Mohamed F.A. Elsisy, Peter A. Noseworthy, Francisco Lopez-Jimenez, Suraj Kapa, Samuel J. Asirvatham, Paul A. Friedman, Juan A. Crestenallo, Mohamad Alkhouli

Research output: Contribution to journalArticlepeer-review


Objective: To assess whether an electrocardiography-based artificial intelligence (AI) algorithm developed to detect severe ventricular dysfunction (left ventricular ejection fraction [LVEF] of 35% or below) independently predicts long-term mortality after cardiac surgery among patients without severe ventricular dysfunction (LVEF>35%). Methods: Patients who underwent valve or coronary bypass surgery at Mayo Clinic (1993-2019) and had documented LVEF above 35% on baseline electrocardiography were included. We compared patients with an abnormal vs a normal AI-enhanced electrocardiogram (AI-ECG) screen for LVEF of 35% or below on preoperative electrocardiography. The primary end point was all-cause mortality. Results: A total of 20,627 patients were included, of whom 17,125 (83.0%) had a normal AI-ECG screen and 3502 (17.0%) had an abnormal AI-ECG screen. Patients with an abnormal AI-ECG screen were older and had more comorbidities. Probability of survival at 5 and 10 years was 86.2% and 68.2% in patients with a normal AI-ECG screen vs 71.4% and 45.1% in those with an abnormal screen (log-rank, P<.01). In the multivariate Cox survival analysis, the abnormal AI-ECG screen was independently associated with a higher all-cause mortality overall (hazard ratio [HR], 1.31; 95% CI, 1.24 to 1.37) and in subgroups of isolated valve surgery (HR, 1.30; 95% CI, 1.18 to 1.42), isolated coronary artery bypass grafting (HR, 1.29; 95% CI, 1.20 to 1.39), and combined coronary artery bypass grafting and valve surgery (HR, 1.19; 95% CI, 1.08 to 1.32). In a subgroup analysis, the association between abnormal AI-ECG screen and mortality was consistent in patients with LVEF of 35% to 55% and among those with LVEF above 55%. Conclusion: A novel electrocardiography-based AI algorithm that predicts severe ventricular dysfunction can predict long-term mortality among patients with LVEF above 35% undergoing valve and/or coronary bypass surgery.

Original languageEnglish (US)
Pages (from-to)3062-3070
Number of pages9
JournalMayo Clinic proceedings
Issue number12
StatePublished - Dec 2021

ASJC Scopus subject areas

  • General Medicine


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