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Assessment and Treatment of Coronary Artery Disease: Current Status, Challenges...
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Assessment and Treatment of Coronary Artery Disease: Current Status, Challenges and Future Directions

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

Deadline for manuscript submissions: closed (15 May 2022) | Viewed by 11361

Special Issue Editor

Dr. Sebastiano Gili

E-Mail Website
Guest Editor
Department of Interventional Cardiology, Centro Cardiologico Monzino, IRCCS, Milan, Italy
Interests: acute coronary syndromes; coronary atherosclerosis; pecutaneuous coronary interventions; Takotsubo syndrome; gender medicine

Special Issue Information

Dear Colleagues,

We are currently working on a Special Issue of the Journal of Clinical Medicine focusing on the treatment of coronary artery disease. Despite remarkable progress in recent decades, coronary artery disease still represents a major public health issue, with a huge impact in terms of mortality, morbidity and quality of life. Great research efforts are still necessary to improve the treatment of this disease.

From primary prevention and pharmacotherapy to invasive treatment, we aim to offer readers a snapshot of the latest advances in the field and to overview the most intriguing challenges ahead and expected developments that may impact our daily clinical practice.

In particular, this Special Issue will focus on:

  • Acute and long-term antithrombotic therapy, particularly with potent antiplatelet inhibitors
  • Novelties in lipid-lowering therapies
  • New invasive and non-invasive tools for the identification of patients and lesions benefiting from coronary revascularization
  • Optimal treatment of high-risk patients (e.g., patients with diabetes and/or chronic kidney disease)
  • Technical advancements in percutaneous revascularization, particularly for complex high-risk indicated procedures (CHIPs)
  • Prognostic assessment of coronary revascularization interventions, both surgical and percutaneous
  •  

We would be very happy to receive your contribution, and we look forward to receiving your input for this exciting project.

Dr. Sebastiano Gili
Guest Editor

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

  • Antithrombotic treatment
  • Lipid-lowering therapy
  • Plaque modification interventions
  • Invasive and non-invasive lesion assessment
  • Coronary revascularization

Published Papers (4 papers)

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Research

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11 pages, 1106 KiB  
Article
Predictors of Mortality and Long-Term Outcome in Patients with Anterior STEMI: Results from a Single Center Study
by Giulia Ferrante, Lucia Barbieri, Carlo Sponzilli, Stefano Lucreziotti, Diego Salerno Uriarte, Marco Centola, Monica Verdoia and Stefano Carugo
J. Clin. Med. 2021, 10(23), 5634; https://doi.org/10.3390/jcm10235634 - 29 Nov 2021
Cited by 5 | Viewed by 1886
Abstract
Anterior ST segment elevation myocardial infarction (A-STEMI) has the worst prognosis among all infarct sites due to larger infarct size and the higher cardiac enzyme release. We retrospectively analyzed 584 A-STEMI undergoing urgent coronary angiography from October 2008 to April 2019. The median [...] Read more.
Anterior ST segment elevation myocardial infarction (A-STEMI) has the worst prognosis among all infarct sites due to larger infarct size and the higher cardiac enzyme release. We retrospectively analyzed 584 A-STEMI undergoing urgent coronary angiography from October 2008 to April 2019. The median follow-up time was 1774 days with a minimum of a 1-year follow-up for 498 patients. In-hospital mortality was 8.6%, while long-term, all-cause mortality and 1-year mortality were 18.8% and 6.8%, respectively. The main predictors for in-hospital mortality were ejection fraction (LV-EF), baseline estimated glomerular filtration rate (eGFR), female gender and cardiogenic shock (CS) at admission, while long-term predictors of mortality were age, coronary artery disease (CAD) extension and LV-EF. Patients presenting with CS (6.5%) showed a higher mortality rate (in-hospital 68.4%, long term 41.7%). Among 245 patients (42%) with multivessel disease (MVD), complete revascularization (CR) during the index procedure was performed in 42.8% of patients and more often in patients with CS at admission (19.1% vs. 6.1%, p = 0.008). Short- and long-term mortality were not significantly influenced by the revascularization strategy (CR/culprit only). Our study confirmed the extreme fragility of A-STEMI patients, especially in case of CS at admission. LV-EF is a powerful predictor of a poor outcome. In MVD, CR during p-PCI did not show any advantage for either long- or short-term mortality compared to the culprit-only strategy. Full article
(This article belongs to the Special Issue Assessment and Treatment of Coronary Artery Disease: Current Status, Challenges and Future Directions)
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14 pages, 985 KiB  
Article
Early Coronary Angiography Is Associated with Improved 30-Day Outcomes among Patients with Out-of-Hospital Cardiac Arrest
by Shir Lynn Lim, Yee How Lau, Mark Y. Chan, Terrance Chua, Huay Cheem Tan, David Foo, Zhan Yun Lim, Boon Wah Liew, Nur Shahidah, Desmond R. Mao, Si Oon Cheah, Michael Y. C. Chia, Han Nee Gan, Benjamin S. H. Leong, Yih Yng Ng, Khung Keong Yeo and Marcus E. H. Ong
J. Clin. Med. 2021, 10(21), 5191; https://doi.org/10.3390/jcm10215191 - 06 Nov 2021
Cited by 5 | Viewed by 2062
Abstract
We evaluated the association between early coronary angiography (CAG) and outcomes in resuscitated out-of-hospital cardiac arrest (OHCA) patients, by linking data from the Singapore Pan-Asian Resuscitation Outcomes Study, with a national registry of cardiac procedures. The 30-day survival and neurological outcome were compared [...] Read more.
We evaluated the association between early coronary angiography (CAG) and outcomes in resuscitated out-of-hospital cardiac arrest (OHCA) patients, by linking data from the Singapore Pan-Asian Resuscitation Outcomes Study, with a national registry of cardiac procedures. The 30-day survival and neurological outcome were compared between patients undergoing early CAG (within 1-calender day), versus patients not undergoing early CAG. Inverse probability weighted estimates (IPWE) adjusted for non-randomized CAG. Of 976 resuscitated OHCA patients of cardiac etiology between 2011–2015 (mean(SD) age 64(13) years, 73.7% males), 337 (34.5%) underwent early CAG, of whom, 230 (68.2%) underwent PCI. Those who underwent early CAG were significantly younger (60(12) vs. 66(14) years old), healthier (42% vs. 59% with heart disease; 29% vs. 44% with diabetes), more likely males (86% vs. 67%), and presented with shockable rhythms (69% vs. 36%), compared with those who did not. Early CAG with PCI was associated with better survival and neurological outcome (adjusted odds ratio 1.91 and 1.82 respectively), findings robust to IPWE adjustment. The rates of bleeding and stroke were similar. CAG with PCI within 24 h was associated with improved clinical outcomes after OHCA, without increasing complications. Further studies are required to identify the characteristics of patients who would benefit most from this invasive strategy. Full article
(This article belongs to the Special Issue Assessment and Treatment of Coronary Artery Disease: Current Status, Challenges and Future Directions)
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14 pages, 2929 KiB  
Article
High-Sensitivity Cardiac Troponin T in Patients with Severe Chronic Kidney Disease and Suspected Acute Coronary Syndrome
by Brunilda Alushi, Fabian Jost-Brinkmann, Adnan Kastrati, Salvatore Cassese, Massimiliano Fusaro, Karl Stangl, Ulf Landmesser, Holger Thiele and Alexander Lauten
J. Clin. Med. 2021, 10(18), 4216; https://doi.org/10.3390/jcm10184216 - 17 Sep 2021
Cited by 5 | Viewed by 2882
Abstract
(1) Background: Patients with severe chronic kidney disease (CKD G4–G5) often have chronically elevated high-sensitivity cardiac troponin T (hs-cTnT) values above the 99th percentile of the upper reference limit. In these patients, optimal cutoff levels for diagnosing non-ST-elevation acute coronary syndrome (NSTE-ACS) requiring [...] Read more.
(1) Background: Patients with severe chronic kidney disease (CKD G4–G5) often have chronically elevated high-sensitivity cardiac troponin T (hs-cTnT) values above the 99th percentile of the upper reference limit. In these patients, optimal cutoff levels for diagnosing non-ST-elevation acute coronary syndrome (NSTE-ACS) requiring revascularization remain undefined. (2) Methods: Of 11,912 patients undergoing coronary angiography from 2012 to 2017 for suspected NSTE-ACS, 325 (3%) had severe CKD. Of these, 290 with available serial hs-cTnT measurements were included, and 300 matched patients with normal renal function were selected as a control cohort. (3) Results: In the CKD cohort, 222 patients (76%) had NSTE-ACS with indication for coronary revascularization. Diagnostic performance was high at presentation and similar to that of the control population (AUC, 95% CI: 0.81, 0.75–0.87 versus 0.85, 0.80–0.89, p = 0.68), and the ROC-derived cutoff value was 4 times higher compared to the conventional 99th percentile. Combining the ROC-derived cutoff levels for hs-cTnT at presentation and absolute 3 h changes, sensitivity increased to 98%, and PPV and NPV improved up to 93% and 86%, respectively. (4) Conclusions: In patients with severe CKD and suspected ACS, the diagnostic accuracy of hs-cTnT for the diagnosis of NSTE-ACS requiring revascularization is improved by using higher assay-specific cutoff levels combined with early absolute changes. Full article
(This article belongs to the Special Issue Assessment and Treatment of Coronary Artery Disease: Current Status, Challenges and Future Directions)
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Review

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15 pages, 3949 KiB  
Review
Comparative Appraisal of Intravascular Ultrasound and Optical Coherence Tomography in Invasive Coronary Imaging: 2022 Update
by Piotr Baruś, Jakub Modrzewski, Karolina Gumiężna, Piotr Dunaj, Marcin Głód, Adrian Bednarek, Wojciech Wańha, Tomasz Roleder, Janusz Kochman and Mariusz Tomaniak
J. Clin. Med. 2022, 11(14), 4055; https://doi.org/10.3390/jcm11144055 - 13 Jul 2022
Cited by 10 | Viewed by 3840
Abstract
Although coronary angiography has been well established as a standard modality for percutaneous coronary intervention guidance, recent developments in intravascular imaging techniques, such as intravascular ultrasound and optical coherence tomography, have become increasingly adopted, enabling direct detailed lesion visualization, including lesions beyond the [...] Read more.
Although coronary angiography has been well established as a standard modality for percutaneous coronary intervention guidance, recent developments in intravascular imaging techniques, such as intravascular ultrasound and optical coherence tomography, have become increasingly adopted, enabling direct detailed lesion visualization, including lesions beyond the scope of assessment using exclusively angiography. Intravascular imaging modalities have been reported to potentially improve both short- and long-term percutaneous intervention outcomes. This review aims to provide a comparative summary of recent advancements in research regarding the clinical applications and outcomes of intravascular ultrasound and optical coherence tomography. Full article
(This article belongs to the Special Issue Assessment and Treatment of Coronary Artery Disease: Current Status, Challenges and Future Directions)
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