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Meas."],"published-print":{"date-parts":[[2026,10,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    <jats:italic>Objective<\/jats:italic>\n                    . Automated electrocardiogram (ECG) classifiers require uncertainty procedures that address class-specific clinical risk in intrinsically multi-label data.\n                    <jats:italic>Approach<\/jats:italic>\n                    . We propose per-class risk-controlling prediction sets for multi-label ECG classification. For each diagnostic class, binary false-negative-rate (FNR) loss is calibrated with a one-sided exact-binomial upper confidence bound. The nine disease-specific targets are controlled simultaneously at 95% family-wise confidence using Bonferroni allocation. The final operating threshold is the more inclusive of the exact-binomial threshold and a conservative reference threshold derived from a concentration bound; this safeguard uses calibration data only and cannot weaken the exact guarantee.\n                    <jats:italic>Main results<\/jats:italic>\n                    . We evaluated the method on PTB-XL (21 388 retained recordings) and Chapman\u2013Shaoxing (10 199 retained recordings), using a patient-disjoint PTB-XL split and fitting-partition-only normalisation. The proposed method met all 9\/9 prespecified disease-specific FNR targets on held-out test sets and produced non-vacuous simultaneous exact-binomial guarantees for all nine targets; uniform standard conformal prediction met 5\/9. Test FNR was 0.0% for myocardial infarction (exact 95% upper bound 0.35%, at 80.3% FPR), 1.0% for ST\/T changes, and 0.3% for atrial fibrillation; the high-sensitivity operating point is purchased with substantially reduced specificity. Under PTB-XL-to-Chapman shift, macro class coverage fell from 94.3% to 45.5%, demonstrating that the guarantees do not transport without local recalibration.\n                    <jats:italic>Significance<\/jats:italic>\n                    . Exact-binomial per-class risk control provides a transparent high-sensitivity operating point for ECG triage while making its specificity, prediction-set-size, calibration-support, and exchangeability limitations explicit.\n                  <\/jats:p>","DOI":"10.1088\/1361-6579\/aeb3c6","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T22:53:07Z","timestamp":1791931987000},"page":"105021","update-policy":"https:\/\/doi.org\/10.1088\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Per-class conformal risk control for multi-label ECG classification: achieving clinically-justified false negative rate guarantees"],"prefix":"10.1088","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3556-0839","authenticated-orcid":true,"given":"Oussama","family":"El Allam","sequence":"first","affiliation":[{"name":"Complex Cyber-Physical Systems Laboratory, The National Superior School of Arts and Crafts, University Hassan II"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7512-4329","authenticated-orcid":false,"given":"Mohamed","family":"Hamlich","sequence":"additional","affiliation":[{"name":"Complex Cyber-Physical Systems Laboratory, The National Superior School of Arts and Crafts, University Hassan II"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]}],"member":"266","published-online":{"date-parts":[[2026,10,30]]},"reference":[{"key":"pmeaaeb3c6bib1","doi-asserted-by":"publisher","first-page":"e139","DOI":"10.1016\/j.jacc.2014.09.017","type":"journal-article","article-title":"2014 AHA\/ACC guideline for the management of patients with non\u2013ST-elevation acute coronary syndromes","volume":"64","author":"Amsterdam","year":"2014","journal-title":"J. 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All rights, including for text and data mining, AI training, and similar technologies, are reserved.","name":"copyright_information","label":"Copyright Information"},{"value":"2026-01-13","name":"date_received","label":"Date Received","group":{"name":"publication_dates","label":"Publication dates"}},{"value":"2026-10-13","name":"date_accepted","label":"Date Accepted","group":{"name":"publication_dates","label":"Publication dates"}},{"value":"2026-10-30","name":"date_epub","label":"Online publication date","group":{"name":"publication_dates","label":"Publication dates"}}]}}