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New Frontiers in the Diagnostics and Clinical Management of Coronary Artery Disease

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

Deadline for manuscript submissions: closed (20 October 2022) | Viewed by 12700

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Prof. Dr. Tomasz Rakowski

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1. 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Kraków, Poland
2. Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Kraków, Poland
Interests: coronary artery disease; acute coronary syndromes; percutaneous coronary interventions; antiplatelet therapy; cardiac imaging
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Dear Colleagues,

Recently, there has been rapid progress in the diagnostic and treatment of coronary artery disease. Advanced, non-invasive imaging techniques, as well as invasive functional assessment, have changed our way of thinking about indications for coronary revascularisation. In addition, new generation stents, invasive coronary imaging modalities, modern pharmacotherapy and growing operator experience have pushed forward the limits of successful percutaneous revascularisations. These have also changed the landscape of restenosis and stent thrombosis problem. Diagnostic strategies and treatment of acute coronary syndromes based on the networking concept have been developed and implemented worldwide, resulting in improved patient outcomes. A large number of clinical studies have provided important knowledge about pharmacotherapy pathways in patients with coronary artery disease. Despite all these advances, coronary artery disease is the leading cause of death worldwide, and there is still an unmet need for further investigations and improvements.

I am pleased to invite you to contribute to this Special Issue on “New Frontiers in the Diagnostics and Clinical Management of Coronary Artery Disease”. The aim is to present original research clinical studies as well as state-of-the-art reviews focused on coronary artery disease diagnostics and treatment.

We are mostly focused on invasive and non-invasive coronary diagnostics (ischemia, viability assessment), coronary revascularization with percutaneous coronary interventions (including procedural technical aspects), pharmacotherapy, secondary prevention, prognostic implications in chronic and acute coronary syndrome patients.

Prof. Dr. Tomasz Rakowski
Guest Editor

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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

Coronary artery disease
Chronic coronary syndromes
Acute coronary syndromes
Percutaneous coronary interventions
Ischemia
Cardiac imaging

Published Papers (7 papers)

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Research

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10 pages, 1513 KiB

Open AccessArticle

Diabetes Mellitus Is Still a Strong Predictor of Periprocedural Outcomes of Primary Percutaneous Coronary Interventions in Patients Presenting with ST-Segment Elevation Myocardial Infarction (from the ORPKI Polish National Registry)

by Artur Dziewierz, Barbara Zdzierak, Krzysztof P. Malinowski, Zbigniew Siudak, Wojciech Zasada, Tomasz Tokarek, Michał Zabojszcz, Magdalena Dolecka-Ślusarczyk, Dariusz Dudek, Stanisław Bartuś, Andrzej Surdacki and Tomasz Rakowski

J. Clin. Med. 2022, 11(21), 6284; https://doi.org/10.3390/jcm11216284 - 25 Oct 2022

Cited by 3 | Viewed by 1376

Abstract

The impact of diabetes mellitus (DM) on outcomes of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) was confirmed by several studies. However, it is unclear whether this effect is still present in large groups of unselected patients undergoing up-to-date treatment. Thus, we sought to assess the impact of DM on periprocedural outcomes of primary PCI in STEMI using data from the Polish National Registry of PCI. Data on 150,782 STEMI patients undergoing primary PCI were collected. Of them, 26,360 (17.5%) patients had DM. Patients with DM were higher-risk individuals who experienced longer reperfusion delays and were less likely to have closed infarct-related artery at baseline (TIMI 0 + 1 flow: 73.2% vs. 72.0%; p < 0.0001) and achieve optimal reperfusion after PCI (TIMI 3 flow: 91.8% vs. 88.5%; p < 0.0001). The periprocedural mortality (1.1% vs. 1.9%; p < 0.0001) was higher in patients with DM and DM was identified as an independent predictor of periprocedural death. In conclusion, despite continuous progress in STEMI treatment, DM remains a strong predictor of periprocedural mortality. However, this detrimental effect of DM may be partially explained by the overall higher risk profile of diabetic patients. Full article

(This article belongs to the Special Issue New Frontiers in the Diagnostics and Clinical Management of Coronary Artery Disease)

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11 pages, 806 KiB

Open AccessArticle

Clinical Outcomes of Biodegradable versus Durable Polymer Drug Eluting Stents in Rotational Atherectomy: Results from ROCK Registry

by Kyung An Kim, Sung-Ho Her, Kyusup Lee, Ik Jun Choi, Jae-Hwan Lee, Jang Hoon Lee, Sang Rok Lee, Pil Hyung Lee, Seung-Whan Lee, Ki Dong Yoo, Su Nam Lee, Won Young Jang, Donggyu Moon, Keon-Woong Moon, Kyeong Ho Yun and Hyun-Jong Lee

J. Clin. Med. 2022, 11(21), 6251; https://doi.org/10.3390/jcm11216251 - 23 Oct 2022

Viewed by 1218

Abstract

Background: The aim of this study was to compare the clinical outcomes of biodegradable polymer (BP) versus durable polymer (DP) drug eluting stents (DES) in patients with calcified coronary lesions who underwent rotational atherectomy (RA) and percutaneous coronary intervention (PCI). Methods: This study was based on a multicenter registry which enrolled patients with calcified coronary artery disease who received PCI using RA during between January 2010 and October 2019 from 9 tertiary centers in Korea. The primary outcome was 3-year all-cause mortality, and the secondary outcomes were cardiovascular death and target-lesion failure. Results: A total of 540 patients who underwent PCI using RA were enrolled with a follow-up period of median 16.1 months. From this registry, 272 patients with PCI using DP-DES and 238 patients with BP-SGDES were selected for analysis. PCI with BP-DES was associated with decreased all-cause mortality after propensity score matching (HR 0.414, CI 0.174–0.988) and multivariate Cox regression analysis (HR 0.458, HR 0.224–0.940). BP-DES was also associated with decreased cardiovascular mortality, but there was no difference in TLF between the two groups. Conclusions: BP-DES were associated with favorable outcomes compared to DP-DES in patients undergoing PCI using RA for calcified coronary lesions. Full article

(This article belongs to the Special Issue New Frontiers in the Diagnostics and Clinical Management of Coronary Artery Disease)

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15 pages, 1310 KiB

Open AccessArticle

LASSO Regression-Based Diagnosis of Acute ST-Segment Elevation Myocardial Infarction (STEMI) on Electrocardiogram (ECG)

by Lin Wu, Bin Zhou, Dinghui Liu, Linli Wang, Ximei Zhang, Li Xu, Lianxiong Yuan, Hui Zhang, Yesheng Ling, Guangyao Shi, Shiye Ke, Xuemin He, Borui Tian, Yanming Chen and Xiaoxian Qian

J. Clin. Med. 2022, 11(18), 5408; https://doi.org/10.3390/jcm11185408 - 15 Sep 2022

Cited by 10 | Viewed by 2353

Abstract

Electrocardiogram (ECG) is an important tool for the detection of acute ST-segment elevation myocardial infarction (STEMI). However, machine learning (ML) for the diagnosis of STEMI complicated with arrhythmia and infarct-related arteries is still underdeveloped based on real-world data. Therefore, we aimed to develop an ML model using the Least Absolute Shrinkage and Selection Operator (LASSO) to automatically diagnose acute STEMI based on ECG features. A total of 318 patients with STEMI and 502 control subjects were enrolled from Jan 2017 to Jun 2019. Coronary angiography was performed. A total of 180 automatic ECG features of 12-lead ECG were input into the model. The LASSO regression model was trained and validated by the internal training dataset and tested by the internal and external testing datasets. A comparative test was performed between the LASSO regression model and different levels of doctors. To identify the STEMI and non-STEMI, the LASSO model retained 14 variables with AUCs of 0.94 and 0.93 in the internal and external testing datasets, respectively. The performance of LASSO regression was similar to that of experienced cardiologists (AUC: 0.92) but superior (p < 0.05) to internal medicine residents, medical interns, and emergency physicians. Furthermore, in terms of identifying left anterior descending (LAD) or non-LAD, LASSO regression achieved AUCs of 0.92 and 0.98 in the internal and external testing datasets, respectively. This LASSO regression model can achieve high accuracy in diagnosing STEMI and LAD vessel disease, thus providing an assisting diagnostic tool based on ECG, which may improve the early diagnosis of STEMI. Full article

(This article belongs to the Special Issue New Frontiers in the Diagnostics and Clinical Management of Coronary Artery Disease)

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11 pages, 466 KiB

Open AccessArticle

Association between High Lipid Burden of Target Lesion and Slow TIMI Flow in Coronary Interventions

by Subin Lim, Jung-Joon Cha, Soon Jun Hong, Ju Hyeon Kim, Hyung Joon Joo, Jae Hyoung Park, Cheol Woong Yu, Tae Hoon Ahn and Do-Sun Lim

J. Clin. Med. 2022, 11(18), 5401; https://doi.org/10.3390/jcm11185401 - 14 Sep 2022

Cited by 2 | Viewed by 1142

Abstract

Decreased thrombolysis in myocardial infarction (TIMI) flow is associated with poor clinical outcomes. However, its predictors are not fully known. A combination of near-infrared spectroscopy (NIRS) and intravascular ultrasound (IVUS) could be used to detect lesions at high risk of slow TIMI flow. This study evaluated 636 consecutive patients undergoing target-lesion NIRS-IVUS imaging prior to percutaneous coronary intervention (PCI). The maximal lipid core burden index over 4-mm segments (maxLCBI₄_mm) per target vessel was calculated. The primary endpoint was the association between maxLCBI₄_mm and post-interventional TIMI flow. A high lipid core burden index (LCBI) cut-off point was determined using receiver-operating characteristic analysis. Decreased TIMI flow (TIMI less than 3) occurred in 90 patients and normal TIMI flow in 546 patients. The decreased TIMI flow group showed significantly higher incidence of cardiovascular events (5.6% vs. 1.5%, log-rank p = 0.010) in three months of composite events including cardiac death, myocardial infarction, stent thrombosis, and target lesion revascularization. In multivariable analysis, a high LCBI (≥354) was independently associated with slow TIMI flow (OR, 2.59 (95% CI, 1.33–5.04), p = 0.005). High LCBI measured using NIRS-IVUS imaging was an independent predictor of decreased post-PCI TIMI flow. Performing PCI for high-LCBI lesions may necessitate adjunctive measures to prevent suboptimal post-PCI reperfusion. Full article

(This article belongs to the Special Issue New Frontiers in the Diagnostics and Clinical Management of Coronary Artery Disease)

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8 pages, 1125 KiB

Open AccessArticle

Early Treatment of Acute Myocardial Infarction with Melatonin: Effects on MMP-9 and Adverse Cardiac Events

by Alberto Domínguez-Rodríguez, Daniel Hernández-Vaquero, Pedro Abreu-González, Néstor Báez-Ferrer, Rocío Díaz, Pablo Avanzas, Fedor Simko, Virginia Domínguez-González, Ramaswamy Sharma and Russel J. Reiter

J. Clin. Med. 2022, 11(7), 1909; https://doi.org/10.3390/jcm11071909 - 30 Mar 2022

Cited by 7 | Viewed by 1648

Abstract

Background: Matrix metalloproteinase-9 (MMP-9) is crucial in tissue remodeling after an adverse cardiac event. In experimental studies, melatonin has been found to attenuate MMP-9 activation. The present study assessed the effects of systemic melatonin administration on the prognosis of patients with acute myocardial infarction (AMI) successfully treated with primary percutaneous coronary intervention, and to examine the effects on MMP-9 levels. Methods: We conducted a randomized controlled trial, enrolling patients who underwent primary percutaneous coronary intervention due to AMI. They were assigned to two groups for melatonin or placebo. The primary endpoint was a combined event of mortality and heart failure readmission at 2 years. The secondary endpoint was the levels of MMP-9 after the percutaneous coronary intervention. Results: Ninety-four patients were enrolled, 45 in the melatonin group and 49 in the control group. At 2 years of follow-up, 13 (13.8%) patients suffered the primary endpoint (3 deaths and 10 readmissions due to heart failure), 3 patients in the melatonin group and 10 in the placebo group. The difference in the restricted mean survival time was 87.5 days (p = 0.02); HR = 0.3 (95% CI 0.08–1.08; p = 0.06); Log-rank test 0.04. After controlling for confounding variables, melatonin administration reduced MMP-9 levels to 90 ng/mL (95% CI 77.3–102.6). Conclusions: This pilot study demonstrated that compared to placebo, melatonin administration was associated with better outcomes in AMI patients undergoing primary percutaneous coronary intervention. Full article

(This article belongs to the Special Issue New Frontiers in the Diagnostics and Clinical Management of Coronary Artery Disease)

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9 pages, 1945 KiB

Open AccessArticle

Effectiveness of a Real-Time X-ray Dosimetry Monitor in Reducing Radiation Exposure in Coronary Procedures: The ESPRESSO-Raysafe Randomized Trial

by Maximilian Olschewski, Helen Ullrich, Moritz Brandt, Sebastian Steven, Majid Ahoopai, Recha Blessing, Aniela Petrescu, Philip Wenzel, Thomas Munzel and Tommaso Gori

J. Clin. Med. 2021, 10(22), 5350; https://doi.org/10.3390/jcm10225350 - 17 Nov 2021

Viewed by 1793

Abstract

Background—Several methods to reduce radiation exposure in the setting of coronary procedures are available on the market, and we previously showed that additional radiation shields reduce operator exposure during radial interventions. We set out to examine the efficacy of real-time personal dosimetry monitoring in a real-world setting of radial artery catheterization. Methods and Results—In an all-comer prospective, parallel study, consecutive coronary diagnostic and intervention procedures were performed with the use of standard radiation shield alone (control group) or with the addition of a real-time dosimetry monitoring system (Raysafe, Billdal, Sweden, monitoring group). The primary outcome was the difference in exposure of the primary operator among groups. Additional endpoints included patient, nurse, second operator exposure and fluoroscopy time. A total of 700 procedures were included in the analysis (n = 369 in the monitoring group). There were no differences among groups in patients’ body mass index (p = 0.232), type of procedure (intervention vs. diagnostic, p = 0.172), and patient sex (p = 0.784). Fluoroscopy time was shorter in the monitoring group (5.6 (5.1–6.2) min vs. 7.0 (6.1–7.7) min, p = 0.023). Radiation exposure was significantly lower in the monitoring group for the patient (135 (115–151) µSv vs. 208 (176–245) µSv, p < 0.0001) but not for the first operator (9 (7–11) µSv vs. 10 (8–11), p = 0.70) and the assistant (2 (1–2) µSv vs. 2 (1–2) µSv, p = 0.121). Conclusions—In clinical daily practice, the use of a real-time dosimetry monitoring device reduces patient radiation exposure and fluoroscopy time without an effect on operator radiation exposure. Full article

(This article belongs to the Special Issue New Frontiers in the Diagnostics and Clinical Management of Coronary Artery Disease)

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Review

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29 pages, 2040 KiB

Open AccessReview

Intracoronary Imaging of Vulnerable Plaque—From Clinical Research to Everyday Practice

by Jacek Legutko, Krzysztof L. Bryniarski, Grzegorz L. Kaluza, Tomasz Roleder, Elzbieta Pociask, Elvin Kedhi, Wojciech Wojakowski, Ik-Kyung Jang and Pawel Kleczynski

J. Clin. Med. 2022, 11(22), 6639; https://doi.org/10.3390/jcm11226639 - 09 Nov 2022

Cited by 4 | Viewed by 2233

Abstract

The introduction into clinical practice of intravascular imaging, including intravascular ultrasound (IVUS), optical coherence tomography (OCT) and their derivatives, allowed for the in vivo assessment of coronary atherosclerosis in humans, including insights into plaque evolution and progression process. Intravascular ultrasound, the most commonly used intravascular modality in many countries, due to its low resolution cannot assess many features of vulnerable plaque such as lipid plaque or thin-cap fibroatheroma. Thus, novel methods were introduced to facilitate this problem including virtual histology intravascular ultrasound and later on near-infrared spectroscopy and OCT. Howbeit, none of the currently used modalities can assess all known characteristics of plaque vulnerability; hence, the idea of combining different intravascular imaging methods has emerged including NIRS-IVUS or OCT-IVUS imaging. All of those described methods may allow us to identify the most vulnerable plaques, which are prone to cause acute coronary syndrome, and thus they may allow us to introduce proper treatment before plaque destabilization. Full article

(This article belongs to the Special Issue New Frontiers in the Diagnostics and Clinical Management of Coronary Artery Disease)

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