# Electrocardiographic Deep Learning for Predicting Post-Procedural Mortality

arXiv: https://arxiv.org/abs/2205.03242 · HTML: https://mlsanity.com/paper/2205.03242/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 5 of its 49 references that are in the map.
- First posted on arXiv 30 Apr 2022.

## Builds on (most cited first, 5 of 5)

- [EfficientNet: Rethinking Model Scaling for Convolutional Neural Networks](https://mlsanity.com/paper/1905.11946/) (2019)
- ["Why Should I Trust You?": Explaining the Predictions of Any Classifier](https://mlsanity.com/paper/1602.04938/) (2016)
- [MobileNetV2: Inverted Residuals and Linear Bottlenecks](https://mlsanity.com/paper/1801.04381/) (2018)
- [Predicting Cardiovascular Risk Factors from Retinal Fundus Photographs using Deep Learning](https://mlsanity.com/paper/1708.09843/) (2017)
- [Deep neural networks can predict mortality from 12-lead electrocardiogram voltage data](https://mlsanity.com/paper/1904.07032/) (2019)

## Built on by (most cited first, 1 of 1)

- [SleepFM: Multi-modal Representation Learning for Sleep Across Brain Activity, ECG and Respiratory Signals](https://mlsanity.com/paper/2405.17766/) (2024)

## Abstract (arXiv)

Background. Pre-operative risk assessments used in clinical practice are limited in their ability to identify risk for post-operative mortality. We hypothesize that electrocardiograms contain hidden risk markers that can help prognosticate post-operative mortality. Methods. In a derivation cohort of 45,969 pre-operative patients (age 59+- 19 years, 55 percent women), a deep learning algorithm was developed to leverage waveform signals from pre-operative ECGs to discriminate post-operative mortality. Model performance was assessed in a holdout internal test dataset and in two external hospital cohorts and compared with the Revised Cardiac Risk Index (RCRI) score. Results. In the derivation cohort, there were 1,452 deaths. The algorithm discriminates mortality with an AUC of 0.83 (95% CI 0.79-0.87) surpassing the discrimination of the RCRI score with an AUC of 0.67 (CI 0.61-0.72) in the held out test cohort. Patients determined to be high risk by the deep learning model's risk prediction had an unadjusted odds ratio (OR) of 8.83 (5.57-13.20) for post-operative mortality as compared to an unadjusted OR of 2.08 (CI 0.77-3.50) for post-operative mortality for RCRI greater than 2. The deep learning algorithm performed similarly for patients undergoing cardiac surgery with an AUC of 0.85 (CI 0.77-0.92), non-cardiac surgery with an AUC of 0.83 (0.79-0.88), and catherization or endoscopy suite procedures with an AUC of 0.76 (0.72-0.81). The algorithm similarly discriminated risk for mortality in two separate external validation cohorts from independent healthcare systems with AUCs of 0.79 (0.75-0.83) and 0.75 (0.74-0.76) respectively. Conclusion. The findings demonstrate how a novel deep learning algorithm, applied to pre-operative ECGs, can improve discrimination of post-operative mortality.