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Current Advances in Acute Coronary Syndrome
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Current Advances in Acute Coronary Syndrome

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (15 May 2023) | Viewed by 24635

Special Issue Editors

Dr. Alberto Cordero

E-Mail Website
Collection Editor
Department of Cardiology, Hospital Universitario de San Juan, Alicante, Spain
Interests: cardiovascular; disease prevention; atherosclerosis; coronary heart disease; cardiology; coronary disease; blood pressure; dyslipidemia
Special Issues, Collections and Topics in MDPI journals
Dr. Clara Bonanad

E-Mail Website
Collection Editor
Cardiology Department, Clinic University Hospital of Valencia, 46010 Valencia, Spain
Interests: cardiovascular disease; atrial fibrillation; frailty; elderly; inflammation; residual risk; anticoagulation; antiplatelet; ACS; CCS
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Individual risk stratification and management of acute coronary syndrome remains a daily challenge due to the wide spectrum of clinical presentations. Clinical guidelines and recommendations have changed substantially in the last decade due to the growing evidence provided by randomized clinical trials involving patients with ST-elevation and non-ST-elevation acute coronary syndromes. Nonetheless, many aspects still remain unsolved and should be investigated in real-world clinical registries. This Topical Collection aims to provide compelling evidence related to the most significant challenges in the context of acute coronary syndromes.

Dr. Alberto Cordero
Dr. Clara Bonanad
Collection Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

acute coronary syndrome
prognosis
revascularization
antiplatelets
primary and secondary prevention
ischemic heart disease
biomarkers
geriatric cardiology
cardiac imaging techniques

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Published Papers (7 papers)

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Research

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15 pages, 1468 KiB  
Article
A Therapeutic Pathway in Patients with Chronic Coronary Syndromes: Proposal for Optimization
by Raffaele De Caterina, Paolo Calabrò, Gianluca Campo, Roberta Rossini and Simona Giubilato
J. Clin. Med. 2022, 11(8), 2091; https://doi.org/10.3390/jcm11082091 - 8 Apr 2022
Viewed by 2161
Abstract
There is uncertainty in cardiologists’ attitudes for prolonging dual antiplatelet therapy (DAPT) with ticagrelor 60 mg beyond 12 months in post-myocardial infarction (MI) patients. We aimed at characterizing the Italian cardiologists’ perceptions and needs in the management of such patients. Two consecutive questionnaires [...] Read more.
There is uncertainty in cardiologists’ attitudes for prolonging dual antiplatelet therapy (DAPT) with ticagrelor 60 mg beyond 12 months in post-myocardial infarction (MI) patients. We aimed at characterizing the Italian cardiologists’ perceptions and needs in the management of such patients. Two consecutive questionnaires were proposed between June and November 2021, and compiled by 122 and 87 Cardiologists, respectively. Agreement among cardiologists was defined as either a >70% frequency of concordant responses relative to total respondents or following the Delphi method as developed by the RAND Corporation. An agreement was reached on the indication of ticagrelor as the first choice P2Y12 inhibitor in MI patients, irrespective of the presentation [ST elevation MI (STEMI), 72%, vs. non-ST elevation MI (NSTEMI), 71%] or the management [invasive vs. conservative (75%)]. A consensus was also achieved on the possibility to consider a patient suitable for long-term DAPT with ticagrelor 60 mg even in case of another P2Y12 inhibitor used in the first year after the acute event (74, 85%). To define ischemic and bleeding risks, a consensus was reached on the utilization of one or more scores (87, 71%). Full article
(This article belongs to the Special Issue Current Advances in Acute Coronary Syndrome)
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8 pages, 241 KiB  
Article
Prevalence of High Bleeding Risk among Hospitalized Suspected NSTEMI Patients
by Henri Kesti, Henna Mäkinen, Kalle Mattila, Samuli Jaakkola, Mikko Lintu and Pekka Porela
J. Clin. Med. 2022, 11(5), 1324; https://doi.org/10.3390/jcm11051324 - 28 Feb 2022
Cited by 3 | Viewed by 2082
Abstract
In recent years, guidelines for the management of acute coronary syndromes (ACS) have placed more emphasis on identifying patients at high bleeding risk (HBR). We set out to investigate the prevalence of HBR patients according to the Academic Research Consortium for High Bleeding [...] Read more.
In recent years, guidelines for the management of acute coronary syndromes (ACS) have placed more emphasis on identifying patients at high bleeding risk (HBR). We set out to investigate the prevalence of HBR patients according to the Academic Research Consortium for High Bleeding Risk (ARC–HBR) criteria in hospitalized patients with suspected non-ST-segment elevation myocardial infarction (NSTEMI). Consecutive patients were retrospectively enrolled between January and June 2019 from the emergency department (ED) of a tertiary hospital. The discharge diagnosis and baseline data were manually collected using electronic patient records and database searches. Patients with non-cardiac diagnoses were excluded. Overall, 212 patients were included in the study. A total of 146 (68.9%) patients were diagnosed with NSTEMI (Type 1), 47 (22.2%) with unstable angina pectoris (UAP) and 19 (9.0%) with “other.” HBR was detected in 47.6% (n = 101) of all patients. Common criteria for HBR among ACS patients were age (40.4%), chronic kidney disease (33.7%), and the use of oral anticoagulation medicines (20.2%). In conclusion, nearly half of the patients hospitalized for ACS fulfilled HBR criteria. According to contemporary guidelines, the management of HBR patients differs from that of non-HBR patients, and thus, a more comprehensive screening for HBR may be considered in clinical practice. Full article
(This article belongs to the Special Issue Current Advances in Acute Coronary Syndrome)
14 pages, 681 KiB  
Article
Risk Assessment after ST-Segment Elevation Myocardial Infarction: Can Biomarkers Improve the Performance of Clinical Variables?
by Alvaro Garcia-Osuna, Jordi Sans-Rosello, Andreu Ferrero-Gregori, Aitor Alquezar-Arbe, Alessandro Sionis and Jordi Ordóñez-Llanos
J. Clin. Med. 2022, 11(5), 1266; https://doi.org/10.3390/jcm11051266 - 25 Feb 2022
Cited by 3 | Viewed by 2140
Abstract
Introduction: Myocardial infarction with ST-segment elevation (STEMI) is the coronary artery disease associated with the highest risk of morbimortality; however, this risk is heterogeneous, usually being evaluated by clinical scores. Risk assessment is a key factor in personalized clinical management of patients with [...] Read more.
Introduction: Myocardial infarction with ST-segment elevation (STEMI) is the coronary artery disease associated with the highest risk of morbimortality; however, this risk is heterogeneous, usually being evaluated by clinical scores. Risk assessment is a key factor in personalized clinical management of patients with this disease. Aim: The aim of this study was to assess whether some new cardiac biomarkers considered alone, combined in a multibiomarker model or in association with clinical variables, improve the short- and long-term risk stratification of STEMI patients. Materials and Methods: This was a retrospective observational study of 253 patients with STEMI. Blood samples were obtained before or during the angiography. The assessed biomarkers were C-terminal fragment of insulin-like growth factor binding protein-4 (CT-IGFBP4), high sensitive cardiac troponin T (hs-cTnT), N-terminal fragment of probrain natriuretic peptide (NT-proBNP), and growth differentiation factor 15 (GDF-15); they reflect different cardiovascular (CV) physiopathological pathways and underlying pathologies. We registered in-hospital and follow-up mortalities and their causes (cardiovascular and all-cause) and major adverse cardiac events (MACE) during a two year follow-up. Discrimination, survival analysis, model calibration, and reclassification of the biomarkers were comprehensively evaluated. Results and Discussion: In total, 55 patients (21.7%) died, 33 in-hospital and 22 during the follow-up, most of them (69.1%) from CV causes; 37 MACE occurred during follow-up. Biomarkers showed good prognostic ability to predict mortality, alone and combined with the multibiomarker model. A predictive clinical model based on age, Killip–Kimball class, estimated glomerular filtration rate (eGFR), and heart rate was derived by multivariate analysis. GDF-15 and NT-proBNP significantly improved risk assessment of the clinical model, as shown by discrimination, calibration, and reclassification of all the end-points except for all-cause mortality. The combination of NT-proBNP and hs-cTnT improved CV mortality prediction. Conclusions: GDF-15 and NT-proBNP added value to the usual risk assessment of STEMI patients. Full article
(This article belongs to the Special Issue Current Advances in Acute Coronary Syndrome)
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16 pages, 1204 KiB  
Article
Acute-Phase Inflammatory Reaction Predicts CMR Myocardial Scar Pattern and 2-Year Mortality in STEMI Patients Undergoing Primary PCI
by Andras Mester, Nora Rat, Theodora Benedek, Diana Opincariu, Roxana Hodas, Monica Chitu and Imre Benedek
J. Clin. Med. 2022, 11(5), 1222; https://doi.org/10.3390/jcm11051222 - 24 Feb 2022
Cited by 4 | Viewed by 1641
Abstract
(1) Background: The inflammatory response following MI plays an important role in the healing, scar formation, and left ventricle (LV) remodeling. Cardiac magnetic resonance (CMR) imaging can accurately quantify the extent of myocardial scarring. The study aimed to investigate: (a) the relationship between [...] Read more.
(1) Background: The inflammatory response following MI plays an important role in the healing, scar formation, and left ventricle (LV) remodeling. Cardiac magnetic resonance (CMR) imaging can accurately quantify the extent of myocardial scarring. The study aimed to investigate: (a) the relationship between acute inflammatory response and the CMR parameters of the scarring extent, and (b) the predictive power of inflammatory biomarkers and myocardial scarring for 2-year mortality. (2) Methods: The study included 202 STEMI patients, who underwent pPCI. Serum hs-CRP, IL-6, P-selectin, E-selectin, I-CAM, and V-CAM levels were determined at admission, and hs-CRP on the fifth day. Patients underwent LGE-CMR after 1 month, for LV volumes, ejection fraction (EF), infarct size (IS), and transmurality. Subjects were divided into tertiles according to the IS, and 2-year all-cause mortality was determined. (3) Results: IL-6 was associated with IS (r = 0.324, p = 0.01), increased transmurality index (r = 0.3, p = 0.01), and lower LVEF (r = −0.3, p = 0.02). Admission hs-CRP levels were not associated with IS, transmurality, or mortality, while hs-CRP at day 5 was a significant predictor for IS (AUC = 0.635, p = 0.05) as well as IL-6 levels (AUC = 0.685, p < 0.001). Mortality was significantly higher in the upper IS tertiles (6% vs. 8.7% vs. 24.52%, p = 0.005). IS was a significant predictor of 2-year mortality (AUC = 0.673, p = 0.002), with a cut-off value of 28.81 g, as well as high transmurality (AUC = 0.641, p = 0.013), with a cut off value of 18.38 g. (4) Conclusions: The serum levels of IL-6 and day-5 hs-CRP predict IS and transmurality, and day-5 hs-CRP levels are independent predictors of 2-year mortality in STEMI patients treated with pPCI. The CMR pattern of myocardial scarring after 1 month, as expressed by the magnitude of IS and transmurality, is a significant predictor for 2-year mortality after revascularized STEMI. Full article
(This article belongs to the Special Issue Current Advances in Acute Coronary Syndrome)
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9 pages, 560 KiB  
Article
Differential Expression of miRNA-223 in Coronary In-Stent Restenosis
by Shiva Ganjali, Seyed Hamid Aghaee-Bakhtiari, Željko Reiner and Amirhossein Sahebkar
J. Clin. Med. 2022, 11(3), 849; https://doi.org/10.3390/jcm11030849 - 6 Feb 2022
Cited by 2 | Viewed by 2201
Abstract
Objective: In-stent restenosis (ISR) is an unfavorable complication that occurs in patients after coronary stenting. Despite the progress with advent of modern DES and new antiplatelet agents, restenosis still hampers PCI short- and long-term results. The aim of this study was to investigate [...] Read more.
Objective: In-stent restenosis (ISR) is an unfavorable complication that occurs in patients after coronary stenting. Despite the progress with advent of modern DES and new antiplatelet agents, restenosis still hampers PCI short- and long-term results. The aim of this study was to investigate whether circulating miRNA-223, which is associated with HDL particles and involved in cholesterol efflux pathway, have diagnostic capability for determining ISR. Methods: This case–control study comprised 21 ISR and 26 NISR patients. The level of miRNA-223 expression was evaluated by TaqMan Real-Time PCR, quantified by the comparative method (fold change) and normalized to U6 expression. Results: Patients in ISR and NISR groups were not different in terms of demographic, clinical, and biochemical parameters, except that the percentage of patients who had DES was significantly greater in the NISR group (88.9%) in comparison with the ISR group (50%). The serum expression of miRNA-223 in ISR patients was 3.277 ± 0.9 times greater than that in NISR group (p = 0.016). In addition, the results of binary logistic regression demonstrated that the high level of serum miRNA-223 was strongly and positively associated with the ISR risk (OR: 17.818, 95% CI: 1.115–284.623, p = 0.042) after adjustment for age, sex, HDL-C, LDL-C, FBS, and statin consumption. Conclusion: Elevated serum level of miRNA-223 might be helpful in predicting the occurrence of ISR. Further confirmation in future large-scale studies is warranted. Full article
(This article belongs to the Special Issue Current Advances in Acute Coronary Syndrome)
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11 pages, 1023 KiB  
Article
Electrocardiographic Predictors of Primary Ventricular Fibrillation and 30-Day Mortality in Patients Presenting with ST-Segment Elevation Myocardial Infarction
by Alberto Cipriani, Gianpiero D’Amico, Giulia Brunetti, Giovanni Maria Vescovo, Filippo Donato, Marco Gambato, Pietro Bernardo Dall’Aglio, Francesco Cardaioli, Martina Previato, Nicolò Martini, Martina Perazzolo Marra, Sabino Iliceto, Luisa Cacciavillani, Domenico Corrado and Alessandro Zorzi
J. Clin. Med. 2021, 10(24), 5933; https://doi.org/10.3390/jcm10245933 - 17 Dec 2021
Cited by 6 | Viewed by 9314
Abstract
Primary ventricular fibrillation (PVF) may occur in the early phase of ST-elevation myocardial infarction (STEMI) prior to primary percutaneous coronary intervention (PCI). Multiple electrocardiographic STEMI patterns are associated with PVF and short-term mortality including the tombstone, Lambda, and triangular QRS-ST-T waveform (TW). We [...] Read more.
Primary ventricular fibrillation (PVF) may occur in the early phase of ST-elevation myocardial infarction (STEMI) prior to primary percutaneous coronary intervention (PCI). Multiple electrocardiographic STEMI patterns are associated with PVF and short-term mortality including the tombstone, Lambda, and triangular QRS-ST-T waveform (TW). We aimed to compare the predictive value of different electrocardiographic STEMI patterns for PVF and 30-day mortality. We included a consecutive cohort of 407 STEMI patients (75% males, median age 66 years) presenting within 12 h of symptoms onset. At first medical contact, 14 (3%) showed the TW or Lambda ECG patterns, which were combined in a single group (TW-Lambda pattern) characterized by giant R-wave and downsloping ST-segment. PVF prior to primary PCI occurred in 39 (10%) patients, significantly more often in patients with the TW-Lambda pattern than those without (50% vs. 8%, p < 0.001). For the multivariable analysis, Killip class ≥3 (OR 6.19, 95% CI 2.37–16.1, p < 0.001) and TW-Lambda pattern (OR 9.64, 95% CI 2.99–31.0, p < 0.001) remained as independent predictors of PVF. Thirty-day mortality was also higher in patients with the TW-Lambda pattern than in those without (43% vs. 6%, p < 0.001). However, only LVEF (OR 0.86, 95% CI 0.82–0.90, p < 0.001) and PVF (OR 4.61, 95% CI 1.49–14.3, p = 0.042) remained independent predictors of mortality. A mediation analysis showed that the effect of TW-Lambda pattern on mortality was mediated mainly via the reduced LVEF. In conclusion, among patients presenting with STEMI, the electrocardiographic TW-Lambda pattern was associated with both PVF before PCI and 30-day mortality. Therefore, this ECG pattern may be useful for early risk stratification of STEMI. Full article
(This article belongs to the Special Issue Current Advances in Acute Coronary Syndrome)
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Review

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15 pages, 331 KiB  
Review
Antithrombotic Therapy in Elderly Patients with Acute Coronary Syndromes
by Clara Bonanad, Francisca Esteve-Claramunt, Sergio García-Blas, Ana Ayesta, Pablo Díez-Villanueva, Jose-Ángel Pérez-Rivera, José Luis Ferreiro, Joaquim Cánoves, Francisco López-Fornás, Albert Ariza Solé, Sergio Raposerias, David Vivas, Regina Blanco, Daznia Bompart Berroterán, Alberto Cordero, Julio Núñez, Lorenzo Fácila, Iván J. Núñez-Gil, José Luis Górriz, Vicente Bodí, Manuel Martínez-Selles, Juan Miguel Ruiz Nodar and Francisco Javier Chorroadd Show full author list remove Hide full author list
J. Clin. Med. 2022, 11(11), 3008; https://doi.org/10.3390/jcm11113008 - 26 May 2022
Cited by 7 | Viewed by 3120
Abstract
The treatment of acute coronary syndrome (ACS) in elderly patients continues to be a challenge because of the characteS.G.B.ristics of this population and the lack of data and specific recommendations. This review summarizes the current evidence about critical points of oral antithrombotic therapy [...] Read more.
The treatment of acute coronary syndrome (ACS) in elderly patients continues to be a challenge because of the characteS.G.B.ristics of this population and the lack of data and specific recommendations. This review summarizes the current evidence about critical points of oral antithrombotic therapy in elderly patients. To this end, we discuss the peculiarities and differences reported referring to dual antiplatelet therapy (DAPT) in ACS management in elderly patients and what might be the best option considering these population characteristics. Furthermore, we analyze antithrombotic strategies in patients with atrial fibrillation (AF), with a particular focus on those cases that also present coronary artery disease (CAD). It is imperative to deepen our knowledge regarding the management of these challenging patients through real-world data and specifically designed geriatric studies to help resolve the questions remaining in their disease management. Full article
(This article belongs to the Special Issue Current Advances in Acute Coronary Syndrome)
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