Deep learning-based treatment decision support framework for multi-vessel coronary artery disease using integrated coronary angiography and clinical data.

BACKGROUND: Treatment selection between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for multi-vessel coronary artery disease remains challenging, requiring careful consideration of both anatomical and clinical factors. METHODS: We developed a deep learning framework that automatically analyzes coronary angiography videos and integrates clinical data to support revascularization decisions. The framework consists of three key modules: (1) a video filtering module for quality screening, (2) a representative frame selection module based on curriculum learning, and (3) a treatment classification module combining imaging features with clinical characteristics. The framework was evaluated using 5,647 patients' data from a single center, with cross-validation. RESULTS: Our framework demonstrated superior performance with a mean AUC of 0.8275 ± 0.0167 in 5-fold cross-validation, significantly outperforming traditional machine learning approaches (baseline AUC: 0.66 ± 0.007, [Formula: see text]). Ablation studies showed sequential improvements: representative frame selection improved performance over baseline by 3.69% (AUC: 0.6657 to 0.7026), video quality filtering provided additional 0.56% improvement (AUC: 0.7026 to 0.7082), and clinical information integration achieved final enhancement of 1.35% (AUC: 0.7082 to 0.7217). For frame selection specifically, curriculum learning outperformed supervised learning by 6.3% (AUC: 0.9067 to 0.9637). CONCLUSIONS: This study provides a promising approach for objective, data-driven decision support in complex coronary revascularization cases. The framework's multi-modal integration strategy and automated analysis capabilities demonstrate potential for improving the consistency and efficiency of treatment selection while maintaining high standards of clinical care. CLINICAL TRIAL NUMBER: Not applicable.