Random forest vs. logistic regression: Predicting angiographic in-stent restenosis after second-generation drug-eluting stent implantation

PLoS One. 2022 May 23;17(5):e0268757. doi: 10.1371/journal.pone.0268757. eCollection 2022.

Abstract

As the rate of percutaneous coronary intervention increases, in-stent restenosis (ISR) has become a burden. Random forest (RF) could be superior to logistic regression (LR) for predicting ISR due to its robustness. We developed an RF model and compared its performance with the LR one for predicting ISR. We retrospectively included 1501 patients (age: 64.0 ± 10.3; male: 76.7%; ISR events: 279) who underwent coronary angiography at 9 to 18 months after implantation of 2nd generation drug-eluting stents. The data were randomly split into a pair of train and test datasets for model development and validation with 50 repeats. The predictive performance was assessed by the area under the curve (AUC) of the receiver operating characteristic (ROC). The RF models predicted ISR with larger AUC-ROCs of 0.829 ± 0.025 compared to 0.784 ± 0.027 of the LR models. The difference was statistically significant in 29 of the 50 repeats. The RF and LR models had similar sensitivity using the same cutoff threshold, but the specificity was significantly higher in the RF models, reducing 25% of the false positives. By removing the high leverage outliers, the LR models had comparable AUC-ROC to the RF models. Compared to the LR, the RF was more robust and significantly improved the performance for predicting ISR. It could cost-effectively identify patients with high ISR risk and help the clinical decision of coronary stenting.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Constriction, Pathologic / etiology
  • Coronary Angiography
  • Coronary Artery Disease* / diagnostic imaging
  • Coronary Artery Disease* / etiology
  • Coronary Artery Disease* / surgery
  • Coronary Restenosis* / diagnostic imaging
  • Coronary Restenosis* / etiology
  • Drug-Eluting Stents* / adverse effects
  • Female
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Percutaneous Coronary Intervention* / adverse effects
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome

Grants and funding

FW recieved the Clinical Research Center Project of Department of Science and Technology of Guizhou Province [NO.(2017)5405]; ZJ recieved the Guizhou Provincial High-level Innovative Talents Project (GZSYQCC[2015]006); WL recieved the Guizhou Provincial Science and Technology Foundation (No.[2019]1197); FW recieved the Guizhou Provincial Science and Technology Social Development Project (No.[2018]2794). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.