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Advances in Diagnosis, Risk Stratification, and Personalized Management in Acute Coronary Syndromes

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

Deadline for manuscript submissions: 20 January 2026 | Viewed by 3862

Special Issue Editors

Dr. Efstratios Karagiannidis

E-Mail Website
Guest Editor
1. Second Department of Cardiology, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
2. Department of Emergency Medicine, AHEPA University Hospital, 54636 Thessaloniki, Greece
Interests: myocardial infarction; heart failure; coronary artery disease; atrial fibrillation; precision medicine
Special Issues, Collections and Topics in MDPI journals
Dr. Barbara P. Fyntanidou

E-Mail Website
Guest Editor
Department of Emergency Medicine, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
Interests: emergency medicine; anesthesia; trauma; cardiopulmonary resuscitation; heart failure
Special Issues, Collections and Topics in MDPI journals
Dr. Aikaterini Apostolopoulou

E-Mail Website
Guest Editor
Department of Emergency Medicine, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
Interests: emergency; cardiac arrest; meta-analysis; clinical epidemiology; primary care medicine
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Cardiovascular disease (CVD) remains the leading cause of death worldwide, with acute coronary syndromes (ACSs) contributing significantly to this high mortality. In recent years, we have witnessed remarkable advancements in our understanding of ACS, from the unraveling of foundational mechanisms and clinical pathophysiology to the discovery of biomarkers that refine diagnosis and treatment. These developments have notably enhanced patient care and outcomes.

However, despite state-of-the-art management, significant residual risk persists, highlighting the need for continued innovations in ACS care. This Special Issue will gather cutting-edge research on prevention, timely diagnosis, risk assessment, and treatment strategies in ACS.

We welcome submissions addressing, but not limited to, the following topics:

  • Novel diagnostic technologies and detection tools;
  • Improved risk stratification methods, scores, and indices;
  • Advances in clinical decision-making and personalized treatment approaches integrating genetics, biomarkers, and clinical data;
  • Strategies for residual risk reduction and evaluations of long-term patient outcomes.

By showcasing these advancements, this Special Issue will provide invaluable insights for researchers and clinicians striving to enhance ACS prognosis and patient quality of life.

We look forward to reading your contributions.

Dr. Efstratios Karagiannidis
Dr. Barbara P. Fyntanidou
Dr. Aikaterini Apostolopoulou
Guest 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 (ACS)
  • cardiovascular disease (CVD)
  • ischemic heart disease
  • emergency medicine
  • risk stratification
  • personalized treatment
  • antiplatelets
  • primary and secondary prevention

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (4 papers)

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Research

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15 pages, 1002 KB  
Article
The Platelet-to-Hemoglobin Ratio as a Prognostic Marker in Patients with Diabetes Mellitus and Acute Coronary Syndrome
by Christos Kofos, Panagiotis Stachteas, Barbara Fyntanidou, Andreas S. Papazoglou, Athanasios Samaras, Athina Nasoufidou, Aikaterini Apostolopoulou, Paschalis Karakasis, Alexandra Arvanitaki, Marios G. Bantidos, Dimitrios V. Moysidis, Nikolaos Stalikas, Dimitrios Patoulias, Marios Sagris, Apostolos Tzikas, George Kassimis, Nikolaos Fragakis and Efstratios Karagiannidis
J. Clin. Med. 2025, 14(19), 6780; https://doi.org/10.3390/jcm14196780 - 25 Sep 2025
Abstract
Background: The platelet-to-hemoglobin ratio (PHR) has emerged as a potential prognostic marker in various cardiovascular contexts, but its role in acute coronary syndrome (ACS), particularly among patients with diabetes mellitus (DM), remains unclear. Methods: In this retrospective cohort study, 843 ACS patients admitted [...] Read more.
Background: The platelet-to-hemoglobin ratio (PHR) has emerged as a potential prognostic marker in various cardiovascular contexts, but its role in acute coronary syndrome (ACS), particularly among patients with diabetes mellitus (DM), remains unclear. Methods: In this retrospective cohort study, 843 ACS patients admitted to the 2nd Cardiology Department at Hippokration Hospital of Thessaloniki, Greece, between 2017 and 2023 were evaluated. PHR was calculated from admission complete blood counts. The primary endpoint was all-cause mortality during a median follow-up of 25 months. Multivariate logistic and Cox regression analyses, receiver operating characteristic (ROC) curves, Kaplan–Meier survival analyses, and restricted cubic spline (RCS) models were employed, with subgroup analyses by DM status. Results: Higher PHR was independently associated with increased mortality in the overall cohort (adjusted hazard ratio [aHR] 1.35, p < 0.001). This association showed stronger predictive value in DM patients, reflected in both a higher aHR (1.52 vs. 1.36 in non-DM patients, p < 0.001 and p = 0.018, respectively) and superior discriminative performance on ROC analysis (AUC 0.707 vs. 0.600 overall, p = 0.0006). Kaplan–Meier analysis confirmed poorer survival in high-PHR groups, especially in DM patients. RCS analysis revealed a J-shaped relationship, with risk increasing markedly beyond PHR values of 2.2. Conclusions: PHR is an independent predictor of long-term mortality in ACS, with greater prognostic significance in DM patients. Its simplicity, low cost, and availability from routine blood tests make it a promising tool for risk stratification in ACS. Full article
(This article belongs to the Special Issue Advances in Diagnosis, Risk Stratification, and Personalized Management in Acute Coronary Syndromes)
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36 pages, 2290 KB  
Article
Diagnostic Biomarkers for Risk Estimation of In-Hospital and Post-Discharge Cardiovascular Mortality in ST-Segment Elevation Myocardial Infarction (STEMI) Patients
by Kristen Kopp, Michael Lichtenauer, Vera Paar, Uta C. Hoppe, Rozana F. Rakhimova, Elena A. Badykova, Eduard F. Agletdinov, Dimitry M. Grishaev, Ksenia A. Cheremisina, Anastasia V. Baraboshkina, Irina A. Lakman, Liya R. Abzalilova and Naufal S. Zagidullin
J. Clin. Med. 2025, 14(18), 6632; https://doi.org/10.3390/jcm14186632 - 20 Sep 2025
Viewed by 279
Abstract
Background: ST-segment-elevation myocardial infarction (STEMI) continues to be associated with substantial short- and long-term cardiovascular (CV) mortality despite advances in treatment. Accurate early risk stratification remains critical for optimizing outcomes. Emerging biomarkers including CRP, sST2, and FABP may enhance predictive precision beyond [...] Read more.
Background: ST-segment-elevation myocardial infarction (STEMI) continues to be associated with substantial short- and long-term cardiovascular (CV) mortality despite advances in treatment. Accurate early risk stratification remains critical for optimizing outcomes. Emerging biomarkers including CRP, sST2, and FABP may enhance predictive precision beyond classical markers. This study aimed to evaluate the prognostic value of these biomarkers for in-hospital and 18-month post-discharge CV mortality in STEMI patients. Methods: In this prospective, single-center study, 179 consecutive STEMI patients admitted September 2020–June 2021 underwent biomarker evaluation upon admission. Serum concentrations of CRP, sST2, and H-FABP were measured by ELISA. Patients were followed for in-hospital outcomes and post-discharge mortality during 18-month follow-up (FU) (last patient, last visit January 2023). ROC analysis was used to determine biomarker cut-off values. Cox regression and Kaplan-Meier analyses assessed associations with mortality. Results: In-hospital mortality was 7.8% (14/179). Elevated CRP (>11 mg/L) was significantly associated with higher in-hospital mortality (21.4% vs. 3.7%, p < 0.01). sST2 and H-FABP showed trends toward worse outcomes at higher levels, although their independent predictive value was less robust. Cox regression identified CRP > 11 mg/L (HR = 4.93, p < 0.01), admission glucose, and reduced GFR as independent predictors of in-hospital mortality. During FU, 18 of 165 discharged patients (10.1%) experienced CV death. Higher sST2 levels were significantly associated with post-discharge mortality in midterm FU (p = 0.041). Conclusions: We could show that CRP > 11 mg/L is a strong predictor of in-hospital mortality while elevated sST2 is associated with CV mortality during midterm FU in STEMI patients. Incorporating these biomarkers into clinical risk models may enhance early risk prediction and identify patients at higher risk for post-discharge events. Full article
(This article belongs to the Special Issue Advances in Diagnosis, Risk Stratification, and Personalized Management in Acute Coronary Syndromes)
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12 pages, 521 KB  
Article
Culprit-Lesion Drug-Coated-Balloon Percutaneous Coronary Intervention in Patients Presenting with ST-Elevation Myocardial Infarction (STEMI)
by Jorge Sanz-Sánchez, Andrea Teira Calderón, David Neves, Carlos Cortés Villar, Antonela Lukic, Eva Rumiz González, Guillermo Sánchez-Elvira, Lino Patricio, José Luis Díez-Gil, Héctor M. García-García, Luis Martínez Dolz, J. Alberto San Román and Ignacio Amat Santos
J. Clin. Med. 2025, 14(3), 869; https://doi.org/10.3390/jcm14030869 - 28 Jan 2025
Viewed by 1971
Abstract
Background/Objectives: Drug-eluting stents (DESs) remain the standard of treatment for patients with ST-elevation myocardial infarction (STEMI). However, complications such as stent thrombosis and in-stent restenosis still pose significant risks. Drug-coated balloons (DCBs) have emerged as a promising alternative, but data for this [...] Read more.
Background/Objectives: Drug-eluting stents (DESs) remain the standard of treatment for patients with ST-elevation myocardial infarction (STEMI). However, complications such as stent thrombosis and in-stent restenosis still pose significant risks. Drug-coated balloons (DCBs) have emerged as a promising alternative, but data for this clinical scenario are still scarce. The objective was to evaluate the safety and efficacy of DCB culprit-lesion primary percutaneous coronary intervention (pPCI) in patients presenting with STEMI and to evaluate its impact on the microcirculatory territory. Methods: An observational retrospective study was conducted across six European centers. Results: In total, 118 patients were included. Of these, 82.2% were male, with a median age of 67 years (IQR 36–92); 28% patients presented with stent thrombosis and most of them (94%) underwent paclitaxel-DCB-pPCI. The median follow-up was 23.2 months (IQR 6.7–77.3). Target lesion failure (TLF) rates were low (3.4%), with no differences between patients presenting with native coronary vessel and stent thrombosis (4.7% vs. 0%; p = 0.205). Overall mortality rates at follow-up were 7%, with only 1.8% attributed to cardiac causes. A target lesion revascularization (TLR) rate of 1.8% was observed, with no target vessel myocardial infarction reported. A subgroup of patients (42; 35.6%) underwent an adenosine-free angiographic microvascular resistance (AMR) analysis. The median AMR was 4.7 (3.9–5.5) and was greater in the stent thrombosis group than in the native coronary group (5.1 vs. 4.6; p = 0.038) with no clinical differences between patients based on the AMR. Conclusions: DCB-pPCI has emerged as an alternative potential treatment for patients presenting with STEMI, with few long-term adverse cardiac events. Despite the encouraging outcomes, these findings underscore the need for a large randomized clinical trial powered by a relevant clinical outcome in order to elucidate the role of DCB-PCI in patients presenting with STEMI. Full article
(This article belongs to the Special Issue Advances in Diagnosis, Risk Stratification, and Personalized Management in Acute Coronary Syndromes)
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Review

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12 pages, 1843 KB  
Review
Coronary Revascularization in Patients with Hemophilia and Acute Coronary Syndrome: Case Report and Brief Literature Review
by Giuseppe Vadalà, Giulia Mingoia, Giuseppe Astuti, Cristina Madaudo, Vincenzo Sucato, Daniele Adorno, Alessandro D’Agostino, Giuseppina Novo, Egle Corrado and Alfredo Ruggero Galassi
J. Clin. Med. 2025, 14(12), 4130; https://doi.org/10.3390/jcm14124130 - 11 Jun 2025
Viewed by 640
Abstract
The current management of patients with acute coronary syndrome (ACS) and bleeding disorders, such as hemophilia, is supported by small retrospective studies or expert consensus documents. Moreover, people with hemophilia are less likely to receive invasive treatments like percutaneous coronary intervention (PCI) or [...] Read more.
The current management of patients with acute coronary syndrome (ACS) and bleeding disorders, such as hemophilia, is supported by small retrospective studies or expert consensus documents. Moreover, people with hemophilia are less likely to receive invasive treatments like percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) for ACS compared to those without hemophilia, which could affect their cardiovascular outcomes. A multidisciplinary team with an expert hematologist is essential to properly define the therapeutic strategy, which should balance both the thrombotic and bleeding risks. We report a clinical case that illustrates an alternative revascularization strategy for hemophilic patients presenting with ACS and with a pattern of diffuse coronary atherosclerotic disease (CAD), encompassing drug-coated balloons (DCBs) in combination with spot stenting. The proposed approach might avoid a full-length drug-eluting stent (DES) implantation and also allow a short dual antiplatelet therapy (DAPT) regimen that is desirable in patients at a very high bleeding risk (HBR) like hemophiliacs. Furthermore, we have provided a review of the available literature on this topic and a focus on the main recommendations for managing ACS, in response to the presented clinical case. Finally, this article aims to share information and develop more confidence in the current guidelines on the treatment of hemophiliacs who need myocardial revascularization. Full article
(This article belongs to the Special Issue Advances in Diagnosis, Risk Stratification, and Personalized Management in Acute Coronary Syndromes)
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