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Special Issue "'Clinical Advances' in Treatment of Acute Coronary Syndrome: Drafting from Theory to Clinical Practice"

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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 (16 September 2023) | Viewed by 9383

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Special Issue Editor

Prof. Dr. Giuseppe De Luca

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Guest Editor

1. Clinical and Experimental Cariology Unit, AOU Sassari, Sassari, Italy
2. Postgraduate School in Cardiovascular Disease, University of Sassari, Sassari, Italy
Interests: myocardial infarction; antithrombotic therapies; atherothrombosis; coronary revascularization; structural heart disease
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Dear Colleagues,

Acute coronary syndromes (ACS) still represent the most frequent causes of morbidity and mortality in developed countries, despite well-organized networks, timely revascularization, improvement in diagnosis, adjunctive pharmacology and mechanical devices. Its prognostic impact has further emerged during the COVID-19 pandemic and is expected to further increase in coming years due to the ageing of the population.

Several issues have not yet fully elucidated and are still largely investigated, such as the identification of new risk factors, the identification of optimal antithrombotic strategies, the advantages of intracoronary imaging, secondary prevention and the management of high-risk subsets such as those with cardiogenic shock, out-of-hospital cardiac arrest, advanced age, diabetes and chronic kidney failure, in addition to gender disparities in the diagnosis and management of ACS.

In this Special Issue, we aim to focus on the contemporary epidemiology, management, outcome and complications, and future directions in the management of acute coronary syndromes

Prof. Dr. Giuseppe De Luca
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

acute coronary syndrome
coronary revascularization
intracoronary imaging
cardiogenic shock
out-of-hospital cardiac arrest
antithrombotic therapies
elderly
bleedings

Published Papers (6 papers)

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Research

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Open AccessArticle

Single versus Dual-Operator Approaches for Percutaneous Coronary Interventions within Chronic Total Occlusion—An Analysis of 27,788 Patients

Krzysztof Piotr Malinowski

Andrzej Surdacki

Wojciech Wańha

Stanisław Bartuś

Aleksandra Piotrowska

Krzysztof Bartuś

Kamil Pytlak

and

Zbigniew Siudak

J. Clin. Med. 2023, 12(14), 4684; https://doi.org/10.3390/jcm12144684 - 14 Jul 2023

Viewed by 435

Abstract

(1) Background: Since the treatment of chronic total occlusion (CTO) with percutaneous coronary intervention (PCI) is associated with high procedural complexity, it has been suggested to use a multi-operator approach. This study was aimed at evaluating the procedural outcomes of single (SO) versus dual-operator (DO) CTO-PCI approaches. (2) Methods: This retrospective analysis included data from the Polish Registry of Invasive Cardiology Procedures (ORPKI), collected between January 2014 and December 2020. To compare the DO and SO approaches, propensity score matching was introduced with equalized baseline features. (3) Results: The DO approach was applied in 3604 (13%) out of 27,788 CTO-PCI cases. Patients undergoing DO CTO-PCI experienced puncture-site bleeding less often than the SO group (0.1% vs. 0.3%, p = 0.03). No differences were found in the technical success rate (successful revascularization with thrombolysis in myocardial infarction flow grade 2/3) of the SO (72.4%) versus the DO approach (71.2%). Moreover, the presence of either multi-vessel (MVD) or left main coronary artery disease (LMCA) (odds ratio (OR), 1.67 (95% confidence interval (CI), 1.20–2.32); p = 0.002), as well as lower annual and total operator volumes of PCI and CTO-PCI, could be noted as factors linked with the DO approach. (4) Conclusions: Due to the retrospective character, the findings of this study have to be considered only as hypothesis-generating. DO CTO-PCI was infrequent and was performed on patients who were more likely to have LMCA lesions or MVD. Operators collaboratively performing CTO-PCIs were more likely to have less experience. Puncture-site bleeding occurred less often in the dual-operator group; however, second-operator involvement had no impact on the technical success of the intervention. Full article

(This article belongs to the Special Issue 'Clinical Advances' in Treatment of Acute Coronary Syndrome: Drafting from Theory to Clinical Practice)

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Current Role of Intracoronary Imaging for Implementing Risk Stratification and Tailoring Culprit Lesion Treatment: A Narrative Review

and

J. Clin. Med. 2023, 12(10), 3393; https://doi.org/10.3390/jcm12103393 - 10 May 2023

Viewed by 804

Abstract

Our understanding of the pathophysiology of acute coronary syndrome and of the vascular biology of coronary atherosclerosis has made enormous progress with the implementation of intravascular imaging. Intravascular imaging contributes to overcoming the known limitations of coronary angiography and allows for the in vivo discrimination of plaque morphology giving insight into the underlying pathology of the disease process. The possibility of using intracoronary imaging to characterize lesion morphologies and correlate them with clinical presentations may influence the treatment of patients and improve risk stratification, offering the opportunity for tailored management. This review examines the current role of intravascular imaging and describes how intracoronary imaging represents a valuable tool for modern interventional cardiology in order to improve diagnostic accuracy and offer a tailored approach to the treatment of patients with coronary artery disease, especially in the acute setting. Full article

(This article belongs to the Special Issue 'Clinical Advances' in Treatment of Acute Coronary Syndrome: Drafting from Theory to Clinical Practice)

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Open AccessReview

New Insights into Pathophysiology and New Risk Factors for ACS

and

J. Clin. Med. 2023, 12(8), 2883; https://doi.org/10.3390/jcm12082883 - 14 Apr 2023

Viewed by 1059

Abstract

Cardiovascular disease still represents the main cause of mortality worldwide. Despite huge improvements, atherosclerosis persists as the principal pathological condition, both in stable and acute presentation. Specifically, acute coronary syndromes have received substantial research and clinical attention in recent years, contributing to improve overall patients’ outcome. The identification of different evolution patterns of the atherosclerotic plaque and coronary artery disease has suggested the potential need of different treatment approaches, according to the mechanisms and molecular elements involved. In addition to traditional risk factors, the finer portrayal of other metabolic and lipid-related mediators has led to higher and deep knowledge of atherosclerosis, providing potential new targets for clinical management of the patients. Finally, the impressive advances in genetics and non-coding RNAs have opened a wide field of research both on pathophysiology and the therapeutic side that are extensively under investigation. Full article

(This article belongs to the Special Issue 'Clinical Advances' in Treatment of Acute Coronary Syndrome: Drafting from Theory to Clinical Practice)

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Contemporary Management of Cardiogenic Shock Complicating Acute Myocardial Infarction

and

J. Clin. Med. 2023, 12(6), 2184; https://doi.org/10.3390/jcm12062184 - 11 Mar 2023

Viewed by 2943

Abstract

Despite an improvement in pharmacological therapies and mechanical reperfusion, the outcome of patients with acute myocardial infarction (AMI) is still suboptimal, especially in patients with cardiogenic shock (CS). The incidence of CS accounts for 3–15% of AMI cases, with mortality rates of 40% to 50%. In contrast to a large number of trials conducted in patients with AMI without CS, there is limited evidence-based scientific knowledge in the CS setting. Therefore, recommendations and actual treatments are often based on registry data. Similarly, knowledge of the available options in terms of temporary mechanical circulatory support (MCS) devices is not equally widespread, leading to an underutilisation or even overutilisation in different regions/countries of these treatment options and nonuniformity in the management of CS. The aim of this article is to provide a critical overview of the available literature on the management of CS as a complication of AMI, summarising the most recent evidence on revascularisation strategies, pharmacological treatments and MCS use. Full article

(This article belongs to the Special Issue 'Clinical Advances' in Treatment of Acute Coronary Syndrome: Drafting from Theory to Clinical Practice)

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Open AccessReview

Secondary Cardiovascular Prevention after Acute Coronary Syndrome: Emerging Risk Factors and Novel Therapeutic Targets

Angelo Silverio

Francesco Paolo Cancro

Maria Giovanna Vassallo

and

J. Clin. Med. 2023, 12(6), 2161; https://doi.org/10.3390/jcm12062161 - 10 Mar 2023

Cited by 1 | Viewed by 2194

Abstract

The control of cardiovascular risk factors, the promotion of a healthy lifestyle, and antithrombotic therapy are the cornerstones of secondary prevention after acute coronary syndrome (ACS). However, many patients have recurrent ischemic events despite the optimal control of traditional modifiable risk factors and the use of tailored pharmacological therapy, including new-generation antiplatelet and lipid-lowering agents. This evidence emphasizes the importance of identifying novel risk factors and targets to optimize secondary preventive strategies. Lipoprotein(a) (Lp(a)) has emerged as an independent predictor of adverse events after ACS. New molecules such as anti-PCSK9 monoclonal antibodies, small interfering RNAs, and antisense oligonucleotides can reduce plasma Lp(a) levels and are associated with a long-term outcome benefit after the index event. The inflammatory stimulus and the inflammasome, pivotal elements in the development and progression of atherosclerosis, have been widely investigated in patients with coronary artery disease. More recently, randomized clinical trials including post-ACS patients treated with colchicine and monoclonal antibodies targeting cytokines yielded promising results in the reduction in major cardiovascular events after an ACS. Gut dysbiosis has also raised great interest for its potential pathophysiological role in cardiovascular disease. This evidence, albeit preliminary and needing confirmation by larger population-based studies, suggests the possibility of targeting the gut microbiome in particularly high-risk populations. The risk of recurrent ischemic events after ACS is related to the complex interaction between intrinsic predisposing factors and environmental triggers. The identification of novel risk factors and targets is fundamental to customizing patient clinical management with a precision medicine perspective. Full article

(This article belongs to the Special Issue 'Clinical Advances' in Treatment of Acute Coronary Syndrome: Drafting from Theory to Clinical Practice)

Open AccessReview

Antiplatelet Strategies for Older Patients with Acute Coronary Syndromes: Finding Directions in a Low-Evidence Field

and

J. Clin. Med. 2023, 12(5), 2082; https://doi.org/10.3390/jcm12052082 - 06 Mar 2023

Cited by 1 | Viewed by 1552

Abstract

Patients ≥ 75 years of age account for about one third of hospitalizations for acute coronary syndromes (ACS). Since the latest European Society of Cardiology guidelines recommend that older ACS patients use the same diagnostic and interventional strategies used by the younger ones, most elderly patients are currently treated invasively. Therefore, an appropriate dual antiplatelet therapy (DAPT) is indicated as part of the secondary prevention strategy to be implemented in such patients. The choice of the composition and duration of DAPT should be tailored on an individual basis, after careful assessment of the thrombotic and bleeding risk of each patient. Advanced age is a main risk factor for bleeding. Recent data show that in patients of high bleeding risk short DAPT (1 to 3 months) is associated with decreased bleeding complications and similar thrombotic events, as compared to standard 12-month DAPT. Clopidogrel seems the preferable P2Y12 inhibitor, due to a better safety profile than ticagrelor. When the bleeding risk is associated with a high thrombotic risk (a circumstance present in about two thirds of older ACS patients) it is important to tailor the treatment by taking into account the fact that the thrombotic risk is high during the first months after the index event and then wanes gradually over time, whereas the bleeding risk remains constant. Under these circumstances, a de-escalation strategy seems reasonable, starting with DAPT that includes aspirin and low-dose prasugrel (a more potent and reliable P2Y12 inhibitor than clopidogrel) then switching after 2–3 months to DAPT with aspirin and clopidogrel for up to 12 months. Full article

(This article belongs to the Special Issue 'Clinical Advances' in Treatment of Acute Coronary Syndrome: Drafting from Theory to Clinical Practice)

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Special Issue "'Clinical Advances' in Treatment of Acute Coronary Syndrome: Drafting from Theory to Clinical Practice"

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