In-hospital and 1-Year Outcomes of Repeated Percutaneous Coronary Intervention for In-stent Restenosis With Acute Coronary Syndrome Presentation

Peculiarities of in-Stent Thrombosis and Restenosis in Coronary Arteries Post-COVID-19: A Systematic Review of Clinical Cases and Case Series

Background

One of the most serious complications of coronary artery stenting is restenosis and in-stent thrombosis; their prevalence can reach 20-25%. Stent thrombosis can be acute (up to 24 hours), subacute (24 hours to 30 days), late (30 days to 1 year), and very late (> 1 year after previous stenting). In the patients with COVID-19 in intensive care units, the proportion of those with elevated troponin levels reached 25%.

Objective

Evaluation of the association between COVID-19 and the development of in-stent thrombosis and restenosis of the coronary arteries based on the analysis of clinical cases and case series.

Materials and Methods

We searched the PubMed and Scopus databases for relevant case reports and case series of stent restenosis and in-stent thrombosis associated with coronavirus infection (CVI) published between 2020 and the present. Thirty-eight full-text publications were screened and manually checked for analysis. We found 10 publications describing cases of thrombosis and restenosis of stents associated with coronavirus infection, of which only 2 were case series. In total, we analyzed 22 cases.

Results

In the structure of in-stent restenosis and thrombosis, 59.1% were very late, 9.1% were late; 18.2% were considered subacute events, and 13.6% were acute events. All cases were angiographically confirmed. The main location of restenosis or thrombosis was the left coronary artery (LAD) (51.1%), thrombosis of the right coronary artery (RCA) occurred in 27.3%, and location in circumflex artery was in 22.7%. All patients had COVID-19 confirmed by a PCR test or the presence of immunoglobulins G and M. In fourteen patients (54.5%), an X-ray examination showed the presence of bilateral polysegmental infiltration.

Conclusion

Analysis of publications demonstrates the association between restenosis and in-stent thrombosis in patients with coronary arteries disease (CAD) and coronavirus infection.

Intelligent prediction of major adverse cardiovascular events (MACCE) following percutaneous coronary intervention using ANFIS-PSO model

Background

This study aimed to use the hybrid method based on an adaptive neuro-fuzzy inference system (ANFIS) and particle swarm optimization (PSO) to predict the long term occurrence of major adverse cardiac and cerebrovascular events (MACCE) of patients underwent percutaneous coronary intervention (PCI) with stent implantation.

Method

This retrospective cohort study included a total of 220 patients (69 women and 151 men) who underwent PCI in Ekbatan medical center in Hamadan city, Iran, from March 2009 to March 2012. The occurrence and non-occurrence of MACCE, (including death, CABG, stroke, repeat revascularization) were considered as a binary outcome. The predictive performance of ANFIS model for predicting MACCE was compared with ANFIS-PSO and logistic regression.

Results

During ten years of follow-up, ninety-six patients (43.6%) experienced the MACCE event. By applying multivariate logistic regression, the traditional predictors such as age (OR = 1.05, 95%CI: 1.02–1.09), smoking (OR = 3.53, 95%CI: 1.61–7.75), diabetes (OR = 2.17, 95%CI: 2.05–16.20) and stent length (OR = 3.12, 95%CI: 1.48–6.57) was significantly predicable to MACCE. The ANFIS-PSO model had higher accuracy (89%) compared to the ANFIS (81%) and logistic regression (72%) in the prediction of MACCE.

Conclusion

The predictive performance of ANFIS-PSO is more efficient than the other models in the prediction of MACCE. It is recommended to use this model for intelligent monitoring, classification of high-risk patients and allocation of necessary medical and health resources based on the needs of these patients. However, the clinical value of these findings should be tested in a larger dataset.