Abstract

Acute myocardial infarction (AMI) is one of the leading cardiovascular diseases worldwide and remains a major cause of mortality. Early risk prediction can help clinicians identify high risk patients shortly after admission and support timely monitoring and individualized treatment. Previous AMI risk assessment approaches predominantly rely on a single model structure or fixed feature representation, which may limit their ability to capture diverse risk related patterns and reduce predictive performance. To address these challenges, we propose MetaAMI, a random projection based meta-learning framework for AMI outcome prediction. Specifically, patients were selected based on ICD-9 and ICD-10 diagnostic codes for AMI from the Medical Information Mart for Intensive Care IV (MIMIC-IV) v3.1 database. Features were transformed through multiple random projections, with each random projection generating a distinct lower dimensional feature representation. Subsequently, baseline classifiers were trained on each lower dimension representation to predict in-hospital mortality among AMI patients. The predictions were aggregated to construct an integrated feature representation, which was used as input to a meta-learner architecture. By effectively integrating complementary information from diverse baseline models, the meta-learner refined the decision boundary and enhanced overall predictive performance. Survival analysis and SHapley Additive exPlanations (SHAP) analysis were further performed to evaluate clinical utility and interpret the model predictions. Benchmarking results based on MIMIC-IV dataset suggested that our MetaAMI consistently outperformed all the baseline classifiers across seven evaluation metrics including Accuracy, Area Under the Curve (AUC), F1 Score, G-Measure, Jaccard Index, Youden J, and Matthews Correlation Coefficient (MCC). In addition, feature importance analysis showed clinically relevant predictors of in-hospital mortality. In summary, MetaAMI provides an effective and robust solution for machine learning based AMI risk prediction. We anticipate that the application of MetaAMI will have a positive impact on clinical risk stratification and personalized treatment strategies for AMI.