Harnessing the power of artificial intelligence in predicting all-cause mortality in transcatheter aortic valve replacement: a systematic review and meta-analysis

Abstract

Objectives: In recent years, the use of artificial intelligence (AI) models to generate individualised risk assessments and predict patient outcomes post-Transcatheter Aortic Valve Implantation (TAVI) has been a topic of increasing relevance in literature. This study aims to evaluate the predictive accuracy of AI algorithms in forecasting post-TAVI mortality as compared to traditional risk scores. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses for Systematic Reviews (PRISMA) standard, a systematic review was carried out. We searched four databases in total—PubMed, Medline, Embase, and Cochrane—from 19 June 2023–24 June, 2023. Results: From 2,239 identified records, 1,504 duplicates were removed, 735 manuscripts were screened, and 10 studies were included in our review. Our pooled analysis of 5 studies and 9,398 patients revealed a significantly higher mean area under curve (AUC) associated with AI mortality predictions than traditional score predictions (MD: −0.16, CI: −0.22 to −0.10, p < 0.00001). Subgroup analyses of 30-day mortality (MD: −0.08, CI: −0.13 to −0.03, p = 0.001) and 1-year mortality (MD: −0.18, CI: −0.27 to −0.10, p < 0.0001) also showed significantly higher mean AUC with AI predictions than traditional score predictions. Pooled mean AUC of all 10 studies and 22,933 patients was 0.79 [0.73, 0.85]. Conclusion: AI models have a higher predictive accuracy as compared to traditional risk scores in predicting post-TAVI mortality. Overall, this review demonstrates the potential of AI in achieving personalised risk assessment in TAVI patients. Registration and protocol: This systematic review and meta-analysis was registered under the International Prospective Register of Systematic Reviews (PROSPERO), under the registration name “All-Cause Mortality in Transcatheter Aortic Valve Replacement Assessed by Artificial Intelligence” and registration number CRD42023437705. A review protocol was not prepared. There were no amendments to the information provided at registration. Systematic Review Registration: https://www.crd.york.ac.uk/, PROSPERO (CRD42023437705).