Modelling prognostic power of cardiac tests using rough sets

Rough sets (Pawlak Z. Rough Sets: Theoretical Aspects of Reasoning about Data, Dordrecht: Kluwer Academic Publishers, 1991) is a relatively new approach to representing and reasoning with incomplete and uncertain knowledge. This article introduces the basic concepts of rough sets and Boolean reasoning (Brown FM. Boolean Reasoning: The Logic of Boolean Equations, Dordrecht: Kluwer Academic Publishers, 1990). A rough set framework is then set up to investigate the prognosis of cardiac events in a set of patients with chest pain that was earlier studied by Geleijnse et al. (J Am Coll Cardiol 1996;28(2):447–454). That study used logistic regression to find that the single most important independent predictor for future hard cardiac events (cardiac death or non-fatal myocardial infarction) was an abnormal scintigraphic scan pattern. However, performing a scintigraphic scan is a relatively expensive procedure, and may for some patients not really be fully necessary as knowledge of the outcome of the scan may be redundant with respect to making a prognosis. Using an approach based on rough sets, this paper explores how a patient group in need of a scintigraphic scan can be identified for subsequent modelling. Identification of such patients may potentially contribute to lowering the cost of medical care and to improving its quality since, virtually without loss of information, fewer patients may be referred for this procedure.