Coronary Artery Disease: From Pathophysiology to Therapeutic Strategies

A special issue of Biomedicines (ISSN 2227-9059). This special issue belongs to the section "Cell Biology and Pathology".

Deadline for manuscript submissions: 30 November 2025 | Viewed by 851

Special Issue Editor


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Guest Editor
Department of Anesthesiology and Intensive Therapy, Silesian Centre for Heart Diseases, Medical University of Silesia, Katowice, Poland
Interests: intensive care; heart failure; mechanical circulatory support; heart transplantation; cardiac anesthesia

Special Issue Information

Dear Colleagues,

This Special Issue, “Coronary Artery Disease: From Pathophysiology to Therapeutic Strategies”, will focus on aspects of the development of coronary artery disease (CAD) and the role of new technologies and therapies in the prevention of myocardial infarction.

Coronary artery disease is one of the most frequent causes of morbidity and mortality in the modern world, classically defined as clinically manifest myocardial ischemia and ischemic chest pain due to a pathological process characterized by non-stenotic and/or stenotic atherosclerotic plaque accumulation in the epicardial arteries.

Based on recent pathophysiological functional and structural insights, more comprehensive concepts and definitions of chronic coronary syndromes (CCSs) have been defined. Consequently, these novel approaches to the clinical presentation and therapies of cardiovascular diseases have resulted in improved guidelines [1]. As is, the cardiovascular model changed from a more static into a more dynamic alteration in macro and microvascular compartments.

Specifically of great interest is coronary microvascular dysfunction, as it is increasingly recognized as a cause of angina and ischemia in non-obstructive coronary arteries (INOCA and ANOCA). Also, there are identified risk factors predisposing the development of coronary atherosclerosis that may also result in impaired vasomotion and/or endothelial function. Different mechanisms of ischemia can act together, and patients may experience unpredictable courses throughout their lifetime.

As a result, improved clinical management strategies have been implemented. These strategies include awareness of the need for primary and secondary prevention by means of close attention being paid to lifestyle factors and guideline-directed medical therapy implementation with newly developed drugs.

Ultimately, treatment of CAD is always aimed at alleviating angina symptoms and preventing acute myocardial infarction or premature death. Clinicians therefore benefit from concise updates on diagnostic and prognostic tools and therapeutic models.

In our Special Issue, we will therefore address the newest insights in clinical diagnostic tools that assess coronary microvascular function. For the issue, we suggest that questions regarding the following be addressed:

  • The role of coronary angiography, or noninvasive approach with the use of stress positron emission tomography or stress magnetic resonance imaging in diagnosis.
  • Can patients with obstructive CAD still benefit from early revascularization or during long-term follow-up?
  • Is the still a place for Heart Team work in decision-making strategies?

The goal is to stimulate research and clinical interest in this exciting field of CAD. The hope is to develop strategies and technologies that can help us address the challenges presented by coronary artery disease.

We cordially invite authors to submit original research and review articles that focus on these exciting pathophysiologic and therapeutic challenges to improving cardiovascular health.

Reference

  1. Vrints C, Andreotti F, Koskinas KC, et al. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J. 2024 Sep 29;45(36):3415-3537

Dr. Pawel Nadziakiewicz
Guest Editor

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Keywords

  • pathophysiological concept of coronary artery disease
  • coronary microvascular dysfunction
  • chronic coronary syndrome
  • acute coronary syndrome
  • post-acute coronary syndrome with heart failure
  • diagnostics in coronary artery disease
  • therapeutic strategies in CAD
  • revascularization

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Published Papers (1 paper)

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21 pages, 2829 KB  
Systematic Review
Comparative Safety of Anticoagulant, Antiplatelet and the Combination of Both for Acute Coronary Syndrome: A Systematic Review and Network Meta-Analysis
by Qingsheng Niu, Ziyi Zhu, Fulin Wang and Yaowen Jiang
Biomedicines 2025, 13(8), 2027; https://doi.org/10.3390/biomedicines13082027 - 20 Aug 2025
Viewed by 638
Abstract
Background: Antithrombotic therapy plays an important role in acute coronary syndrome (ACS). The combination of anticoagulant and antiplatelet therapy resulted in fewer complications and stronger potency compared to traditional monotherapy. Our net meta-analysis aimed to compare and rank the safety of different treatments [...] Read more.
Background: Antithrombotic therapy plays an important role in acute coronary syndrome (ACS). The combination of anticoagulant and antiplatelet therapy resulted in fewer complications and stronger potency compared to traditional monotherapy. Our net meta-analysis aimed to compare and rank the safety of different treatments used in patients with ACS. Method: We conducted a search for trials in three prominent databases. The main objective of our investigation was to assess hemorrhage. Additional outcomes included mortality, myocardial infarction, stroke, and embolism. We used a frequentist network meta-analysis with a random-effects model to, directly and indirectly, compare safety across different antithrombotic strategies. Result: A total of 30 randomized clinical trials were included in this net meta-analysis with 135,471 ACS patients. In these eight different antithrombotic therapies, SAPT (single-agent platelet inhibitor therapy) showed the lowest risk of bleeding (SUCRA = 0.5%). The highest risk of bleeding was observed in VKA (vitamin K antagonists) + DAPT (dual antiplatelet therapy) (SUCRA = 99.8%). Bleeding among NOAC (non-vitamin K antagonist oral anticoagulants) + DAPT was found to be higher than DAPT (OR = 1.94, 95% CI = 1.42–2.65). NOAC + SAPT significantly reduced the embolism (OR = 1.50, 95% CI = 1.16–1.94) and myocardial infarction (OR = 1.22, 95% CI = 1.08–1.37) events compared with SAPT. In addition, VKA significantly reduced the rate of stroke compared with SAPT (OR = 3.45, 95% CI = 1.17–10.18). However, no significant difference was observed in death events among these eight antithrombotic therapies. Conclusions: We advise against the use of SAPT in ACS due to its elevated risk of embolism, myocardial infarction, and stroke. It is important to mention that the combination of NOAC and SAPT has a lower incidence of myocardial infarction, bleeding and embolism problems. Therefore, the combination of NOAC and SAPT may be the optimal approach to achieve a balance between the risks of bleeding and embolism. This meta-analysis was registered in PROSPERO with the registration number CRD42024542826. Full article
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