Assessing the Predictive Value of Kolmogorov–Arnold Networks for the No-Reflow Phenomenon in ST-Segment Elevation Myocardial Infarction: A Comparative Machine Learning Study

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OBJECTIVE: The no-reflow phenomenon in ST-segment elevation myocardial infarction (STEMI) is a significant clinical issue associated with poor cardiovascular outcomes. This study aimed to develop and compare multiple supervised machine learning algorithms, including the recently introduced Kolmogorov-Arnold Network (KAN), to predict the occurrence of the no-reflow phenomenon in patients with STEMI undergoing primary percutaneous coronary intervention (PCI). METHOD: This prospective, single-center study included 890 consecutive STEMI patients undergoing primary PCI. The Synthetic Minority Over-sampling Technique (SMOTE) was utilized to address class imbalance during training. Feature selection using analysis of variance (ANOVA) F-statistics and validation of feature independence (Variance Inflation Factor [VIF] < 5) identified ejection fraction (EF), baseline troponin level, stent length, B-type natriuretic peptide (BNP) level, and total ischemic time as the most influential predictors. RESULTS: The KAN and Extreme Gradient Boosting (XGBoost) models achieved the highest predictive accuracy (area under the curve > 0.98, F1 > 0.95), outperforming traditional models such as logistic regression and decision tree classifiers (DeLong test, P < 0.001). Feature selection improved efficiency and reduced runtime by 20-40%, while Shapley Additive exPlanations-based (SHAP-based) explainability confirmed that the predictions were physiologically consistent: higher EF and lower BNP reduced the probability of no-reflow, whereas longer stent length and ischemic time increased it. The superior performance of KAN and XGBoost underscores the importance of modeling nonlinear relationships and multidimensional interactions among clinical, laboratory, and procedural variables. CONCLUSION: These findings suggest that KAN may serve as a reliable analytical framework for exploring complex cardiovascular outcomes. However, further multicenter and externally validated studies are needed to confirm its generalizability and potential role in clinical risk assessment.

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