Dynamic isolation forest for anomaly detection in post-PCI myocardial infarction patients

Patients with myocardial infarction require continuous monitoring of multiple laboratory parameters after percutaneous coronary intervention (PCI), but assessment of their dynamic changes and of whether they deviate from the typical recovery trajectory still relies largely on clinical experience, and objective methods remain lacking. This study included 183 patients with myocardial infarction who underwent PCI, constructed fixed three-time-point windows, used blinded expert review as the reference, compared dynamic isolation forest (DIF) with other unsupervised methods, and conducted an external supportive prognostic analysis in MIMIC-IV. The results showed that DIF had the best agreement with expert ratings (Spearman's ρ = 0.585; Kendall's τ = 0.452), with an AUC of 0.859, and overall outperformed the other methods; the MIMIC-IV analysis showed that higher DIF anomaly scores were associated with an increased risk of death. DIF can be used to identify abnormal recovery windows after PCI that deviate from the typical recovery trajectory and may have potential for risk stratification, although its clinical utility still requires further validation.