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Acute Coronary Syndrome: Current State of Diagnosis and Treatment
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Acute Coronary Syndrome: Current State of Diagnosis and Treatment

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

Deadline for manuscript submissions: closed (25 March 2024) | Viewed by 3660

Special Issue Editors

Prof. Dr. Roy Beigel

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Guest Editor
The Cardiovascular Division, Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, The Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
Interests: acute coronary syndrome; myocardial infarction; heart failure; echocardiography; clinical cardiology; pulmonary embolism
Dr. Fernando Chernomordik

E-Mail Website
Guest Editor
The Cardiovascular Division, Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, The Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
Interests: acute coronary syndrome; heart failure; acute myocarditis; clinical cardiology
Dr. Alexander Fardman

E-Mail Website
Guest Editor
The Cardiovascular Division, Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, The Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
Interests: acute coronary syndrome; heart failure; mechanical circulatory support; heart transplantation; acute myocarditis

Special Issue Information

Dear Colleagues,

This Special Issue of the Journal of Clinical Medicine will highlight the latest in the diagnosis and treatment of acute coronary syndromes (ACS). Coronary disease is one of leading causes of morbidity and mortality worldwide. Each year, over 7 million people are diagnosed with ACS, with a 5% mortality rate before hospital discharge. During the last few years, new advances have been developed in the diagnosis and management of ACS. These cover evaluation from the prehospital setting, including novel-biomarker kits, throughout evaluation at the bedside in the hospital and management following discharge. The acute management, including percutaneous coronary interventions, modern antiplatelet medications, lipids lowering therapies, as well as the use of traditional and novel risk scores, has the potential to improve patient outcomes. Sex differences are also a contemporary focus in the evaluation and management of these patients, recognizing the importance of tailored approaches.

This Special Issue provides researchers with the opportunity to publish both original research and review articles related to recent advances in the field of ACS, with a particular focus on new diagnostic methods for risk stratification, innovative imaging studies for diagnosis and management of patients with an ACS, novel antiplatelet drugs, and the use of precision medicine.

Prof. Dr. Roy Beigel
Dr. Fernando Chernomordik
Dr. Alexander Fardman
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
  • ant-platelet therapy
  • myocardial infarction
  • percutaneous interventions
  • cardiogenic shock

Published Papers (5 papers)

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Research

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13 pages, 1030 KiB  
Article
The Role of Pan-Immune-Inflammation Value in Determining the Severity of Coronary Artery Disease in NSTEMI Patients
by Zeki Cetinkaya, Saban Kelesoglu, Aydin Tuncay, Yucel Yilmaz, Yucel Karaca, Mehdi Karasu, Ozlem Secen, Ahmet Cinar, Murat Harman, Seyda Sahin, Yusuf Akin and Ozkan Yavcin
J. Clin. Med. 2024, 13(5), 1295; https://doi.org/10.3390/jcm13051295 - 25 Feb 2024
Cited by 1 | Viewed by 578
Abstract
Background: Even though medication and interventional therapy have improved the death rate for non-ST elevation myocardial infarction (NSTEMI) patients, these patients still have a substantial residual risk of cardiovascular events. Early identification of high-risk individuals is critical for improving prognosis, especially in this [...] Read more.
Background: Even though medication and interventional therapy have improved the death rate for non-ST elevation myocardial infarction (NSTEMI) patients, these patients still have a substantial residual risk of cardiovascular events. Early identification of high-risk individuals is critical for improving prognosis, especially in this patient group. The focus of recent research has switched to finding new related indicators that can help distinguish high-risk patients. For this purpose, we examined the relationship between the pan-immune-inflammation value (PIV) and the severity of coronary artery disease (CAD) defined by the SYNTAX score (SxS) in NSTEMI patients. Methods: Based on the SxS, CAD patients were split into three groups. To evaluate the risk variables of CAD, multivariate logistic analysis was employed. Results: The PIV (odds ratio: 1.003; 95% CI: 1.001–1.005; p = 0.005) was found to be an independent predictor of a high SxS in the multivariate logistic regression analysis. Additionally, there was a positive association between the PIV and SxS (r: 0.68; p < 0.001). The PIV predicted the severe coronary lesion in the receiver-operating characteristic curve analysis with a sensitivity of 91% and specificity of 81.1%, using an appropriate cutoff value of 568.2. Conclusions: In patients with non-STEMI, the PIV, a cheap and easily measured laboratory variable, was substantially correlated with a high SxS and the severity of CAD. Full article
(This article belongs to the Special Issue Acute Coronary Syndrome: Current State of Diagnosis and Treatment)
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11 pages, 873 KiB  
Article
The Impact of Sex on Cardiogenic Shock Outcomes Following ST Elevation Myocardial Infarction
by Joshua H. Arnold, Leor Perl, Abid Assali, Pablo Codner, Gabriel Greenberg, Abid Samara, Avital Porter, Katia Orvin, Ran Kornowski and Hana Vaknin Assa
J. Clin. Med. 2023, 12(19), 6259; https://doi.org/10.3390/jcm12196259 - 28 Sep 2023
Viewed by 689
Abstract
Background: Cardiogenic shock (CS) remains the leading cause of ST elevation myocardial infarction (STEMI)-related mortality. Contemporary studies have shown no sex-related differences in mortality. Methods: STEMI-CS patients undergoing primary percutaneous coronary intervention (PPCI) were included based on a dedicated prospective STEMI database. We [...] Read more.
Background: Cardiogenic shock (CS) remains the leading cause of ST elevation myocardial infarction (STEMI)-related mortality. Contemporary studies have shown no sex-related differences in mortality. Methods: STEMI-CS patients undergoing primary percutaneous coronary intervention (PPCI) were included based on a dedicated prospective STEMI database. We compared sex-specific differences in CS characteristics at baseline, during hospitalization, and in subsequent clinical outcomes. Endpoints included all-cause mortality and major adverse cardiac events (MACE). Results: Of 3202 consecutive STEMI patients, 210 (6.5%) had CS, of which 63 (30.0%) were women. Women were older than men (73.2 vs. 65.5% y, p < 0.01), and more had hypertension (68.3 vs. 52.8%, p = 0.019) and diabetes (38.7 vs. 24.8%, p = 0.047). Fewer were smokers (13.3 vs. 41.2%, p < 0.01), had previous PCI (9.1 vs. 22.3% p = 0.016), or required IABP (35.3 vs. 51.1% p = 0.027). Women had higher rates of mortality (53.2 vs. 35.3% in-hospital, p = 0.01; 61.3 vs. 41.9% at 1 month, p = 0.01; and 73.8 vs. 52.6% at 3 years, p = 0.05) and MACE (60.6 vs. 41.6% in-hospital, p = 0.032; 66.1 vs. 45.6% at 1 month, p = 0.007; and 62.9 vs. 80.3% at 3 years, p = 0.015). After multivariate adjustment, female sex remained an independent factor for death (HR-2.42 [95% CI 1.014–5.033], p = 0.042) and MACE (HR-1.91 [95% CI 1.217–3.031], p = 0.01). Conclusions: CS complicating STEMI is associated with greater short- and long-term mortality and MACE in women. Sex-focused measures to improve diagnosis and treatment are mandatory for CS patients. Full article
(This article belongs to the Special Issue Acute Coronary Syndrome: Current State of Diagnosis and Treatment)
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Review

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13 pages, 891 KiB  
Review
Revascularization Strategy in Myocardial Infarction with Multivessel Disease
by Alexander Jobs, Steffen Desch, Anne Freund, Hans-Josef Feistritzer and Holger Thiele
J. Clin. Med. 2024, 13(7), 1918; https://doi.org/10.3390/jcm13071918 - 26 Mar 2024
Viewed by 593
Abstract
The proportion of patients with multivessel coronary artery disease in individuals experiencing acute coronary syndrome (ACS) varies based on age and ACS subtype. In patients with ST-segment elevation myocardial infarction (STEMI) without cardiogenic shock, the prognostic benefit of complete revascularization has been demonstrated [...] Read more.
The proportion of patients with multivessel coronary artery disease in individuals experiencing acute coronary syndrome (ACS) varies based on age and ACS subtype. In patients with ST-segment elevation myocardial infarction (STEMI) without cardiogenic shock, the prognostic benefit of complete revascularization has been demonstrated by several randomized trials and meta-analyses, leading to a strong guideline recommendation. However, similar data are lacking for ACS without ST-segment elevation (NSTE-ACS). Non-randomized data suggesting a benefit from complete revascularization in non-ST-segment elevation myocardial infarction (NSTEMI) are prone to selection bias and should be interpreted with caution. A series of large randomized controlled trials have been initiated recently to address these open questions. Full article
(This article belongs to the Special Issue Acute Coronary Syndrome: Current State of Diagnosis and Treatment)
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Other

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17 pages, 3553 KiB  
Systematic Review
Cardiovascular Outcomes after Paclitaxel-Coated Balloon Angioplasty versus Drug-Eluting Stent Placement for Acute Coronary Syndrome: A Systematic Review and Meta-Analysis
by Yuki Kondo, Tetsuya Ishikawa, Masatoshi Shimura, Kota Yamada, Tomoaki Ukaji, Yohei Tamura, Miona Arai, Kahoko Mori, Taro Takeyama, Yuichi Hori, Itaru Hisauchi, Shiro Nakahara, Yuji Itabashi, Sayuki Kobayashi and Isao Taguchi
J. Clin. Med. 2024, 13(5), 1481; https://doi.org/10.3390/jcm13051481 - 04 Mar 2024
Viewed by 634
Abstract
Background: We conducted a systematic review and meta-analysis to examine the feasibility of paclitaxel-coated balloon (PCB) angioplasty for de novo lesions in patients with acute coronary syndrome (ACS) by comparing with drug-eluting stent (DES) placement. Methods: By a systematic literature search, [...] Read more.
Background: We conducted a systematic review and meta-analysis to examine the feasibility of paclitaxel-coated balloon (PCB) angioplasty for de novo lesions in patients with acute coronary syndrome (ACS) by comparing with drug-eluting stent (DES) placement. Methods: By a systematic literature search, nine (five randomized controlled, two retrospective propensity-score matched, and two retrospective baseline-balanced) studies comparing the midterm clinical and angiographic outcomes after PCB angioplasty and DES placement were included, yielding 974 and 1130 ACS cases in PCB and DES groups, respectively. Major adverse cardiac event (MACE) was defined as a composite of cardiac mortality (CM), all-cause mortality (ACM), myocardial infarction (MI), target vessel revascularization (TVR), and target lesion revascularization (TLR). Late luminal loss (LLL) and bleeding events (BLD) were also estimated. Results: The frequencies of MACE in PCB and DES groups were 8.42% and 10.62%, respectively. PCB angioplasty had no significant impacts on all of MACE (risk ratio: 0.90, 95%CI: 0.68–1.18, p = 0.44), CM, ACM, MI, TVR, TLR, BLD, and LLL, compared to DES placement in random-effects model. Conclusions: The present systematic review and meta-analysis showed the feasibility of PCB angioplasty for the de novo lesions in patients with ACS in comparison with DES placement by the emergent procedures. Full article
(This article belongs to the Special Issue Acute Coronary Syndrome: Current State of Diagnosis and Treatment)
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11 pages, 1257 KiB  
Systematic Review
The Prognostic Role of Platelet-to-Lymphocyte Ratio in Acute Coronary Syndromes: A Systematic Review and Meta-Analysis
by Michal Pruc, Frank William Peacock, Zubaid Rafique, Damian Swieczkowski, Krzysztof Kurek, Monika Tomaszewska, Burak Katipoglu, Maciej Koselak, Basar Cander and Lukasz Szarpak
J. Clin. Med. 2023, 12(21), 6903; https://doi.org/10.3390/jcm12216903 - 02 Nov 2023
Viewed by 850
Abstract
This study aimed to investigate the potential prognostic role of the platelet-to-lymphocyte (PLR) ratio in patients presenting with suspected acute coronary syndromes (ACS). A systematic search of PubMed Central, Scopus, EMBASE, and the Cochrane Library from conception through 20 August 2023 was conducted. [...] Read more.
This study aimed to investigate the potential prognostic role of the platelet-to-lymphocyte (PLR) ratio in patients presenting with suspected acute coronary syndromes (ACS). A systematic search of PubMed Central, Scopus, EMBASE, and the Cochrane Library from conception through 20 August 2023 was conducted. We used odds ratios (OR) as the effect measure with 95% confidence intervals (CIs) for dichotomous data and mean differences (MD) with a 95% CI for continuous data. If I2 was less than 50% or the p value of the Q tests was less than 0.05, a random synthesis analysis was conducted. Otherwise, a fixed pooled meta-analysis was performed. Nineteen studies fulfilled the eligibility criteria and were included in the meta-analysis. PLR was higher in MACE-positive (164.0 ± 68.6) than MACE-negative patients (115.3 ± 36.9; MD = 40.14; 95% CI: 22.76 to 57.52; p < 0.001). Pooled analysis showed that PLR was higher in AMI patients who died (183.3 ± 30.3), compared to survivors (126.2 ± 16.8; MD = 39.07; 95% CI: 13.30 to 64.84; p = 0.003). It was also higher in the ACS vs. control group (168.2 ± 81.1 vs. 131.9 ± 37.7; MD = 39.01; 95% CI: 2.81 to 75.21; p = 0.03), STEMI vs. NSTEMI cohort (165.5 ± 92.7 vs. 159.5 ± 87.8; MD = 5.98; 95% CI: −15.09 to 27.04; p = 0.58), and MI vs. UAP populations (162.4 ± 90.0 vs. 128.2 ± 64.9; MD = 18.28; 95% CI: −8.16 to 44.71; p = 0.18). Overall, our findings confirmed the potential prognostic role of the plate-let-to-lymphocyte (PLR) ratio in patients presenting with suspected acute coronary syndromes (ACS). Its use as a risk stratification tool should be examined prospectively to define its capability for evaluation in cardiovascular patients. Full article
(This article belongs to the Special Issue Acute Coronary Syndrome: Current State of Diagnosis and Treatment)
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