Diagnostic Test Accuracy of artificial intelligence-assisted detection of acute coronary syndrome: A systematic review and meta-analysis

Artificial intelligence (AI) has potential uses in healthcare including the detection of health conditions and prediction of health outcomes. Past systematic reviews had reviewed the accuracy of artificial neural networks (ANN) on Electrocardiogram (ECG) readings but that of other AI models on other Acute Coronary Syndrome (ACS) detection tools remains unclear. Nine electronic databases were searched from 2012 to 31 August 2022 including grey literature search and hand searching of references of included articles. Risk of bias was assessed by two independent reviewers using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Test characteristics namely true positives, false positives, true negatives, and false negatives were extracted from all included articles into a 2x2 table. Study-specific estimates of sensitivity and specificity were pooled using hierarchical summary receiver operating characteristic (HSROC) model and displayed using a forest plot and HSROC curve. 66 studies were included in the review. A total of 518,931 patients were included whose mean ages varied from 32.62 to 70 years old. In 66 studies, the sensitivity and specificity of AI-based detection for ACS screening ranged from 64 % to 100 % and 65 %–100 %, respectively. The overall quality of evidence was low due to the inclusion of case-control studies. Results of the study inform the potential of using AI-assisted ACS detection for accurate diagnosis and prompt treatment for ACS. Adherence to the Standards for Reporting of Diagnostic Accuracy (STARD) guideline and having more cohort studies for future Diagnostic Test Accuracy (DTA) studies are necessary to improve the quality of evidence of AI-based detection of ACS.