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Myocardial Infarction 2021

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A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Medical Research".

Deadline for manuscript submissions: closed (25 February 2022) | Viewed by 31193

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Prof. Dr. Theodora Benedek

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George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, Gheorge Marinescu Street, no. 38, 540142 Târgu Mureș, Romania
Interests: cardiology; cardiac imaging; acute coronary syndromes; atherosclerosis; heart failure

Prof. Dr. Ciprian Rezus

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Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 16 University Street, 700115 Iasi, Romania
Interests: cardiology; internal medicine; heart failure; atherosclerosis; arterial hypertension
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Imre Benedek

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George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, Gheorge Marinescu Street, no. 38, 540142 Târgu Mureș, Romania
Interests: interventional cardiology

Special Issue Information

Dear Colleagues,

Cardiovascular diseases are the leading cause of deaths worldwide, and acute myocardial infarction is still responsible for a significant number of preventable deaths. In the recent months, the COVID-19 pandemic has led to a significant decrease in the number of patients with acute coronary syndromes who have managed to arrive in time to cath labs for the guideline-recommended revascularization procedure. Inflammation plays a pivotal role in the pathophysiology of acute myocardial infarction, with different conditions associated with increased inflammation being associated with a higher incidence of infarction or with a higher severity of this condition. The aim of this Special Issue is to present the most recent progress in understanding the pathophysiological mechanisms associated with myocardial infarction. Articles addressing the link between inflammatory diseases and myocardial infarction, as well as studies reflecting the impact of the COVID-19 pandemic on AMI-related mortality, are very welcome.

This issue will also welcome any study presenting the most recent developments in the diagnosis and management of myocardial infarction, including modern imaging techniques, new tools for the detection of vulnerable plaques, novel biomarkers for diagnosis or risk stratification, modern therapies in the acute phase or in the rehabilitation period, and new concepts and hypotheses to explain the inflammatory link between infarction and SARS-CoV-2 infection.

Prof. Dr. Theodora Benedek
Prof. Dr. Ciprian Rezus
Prof. Dr. Imre Benedek
Guest Editors

Manuscript Submission Information

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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. Life is an international peer-reviewed open access monthly 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

myocardial infarction
acute coronary syndromes
STEMI networks
coronary inflammation

Published Papers (10 papers)

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Research

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15 pages, 2310 KiB

Open AccessArticle

Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting for Non-Protected Left Main Coronary Artery Disease: 1-Year Outcomes in a High Volume Single Center Study

by Ștefan Dan Cezar Moț, Adela Mihaela Șerban, Ruxandra Ștefana Beyer, Mihai Cocoi, Horia Iuga, Ioana Dănuța Mureșan, Simona Cozma, Alexandra Dădârlat-Pop, Raluca Tomoaia and Dana Pop

Life 2022, 12(3), 347; https://doi.org/10.3390/life12030347 - 27 Feb 2022

Viewed by 2210

Abstract

Introduction: There is clear evidence of a significant reduction in all major cardiovascular adverse events (MACE) by coronary artery bypass grafting (CABG) in left main coronary artery stenosis (LMCS), but revascularization by percutaneous coronary artery intervention (PCI) shows an increasingly important role as an alternative to CABG. Several recent trials aiming to test the difference in mortality between the two types of revascularization found conflicting data. The aim of this study is to determine whether PCI is non-inferior to CABG with respect to the occurrence of MACE at 1 year in patients with significant LMCS. Material and methods: We prospectively enrolled 296 patients with chronic or acute coronary syndromes and significant LM stenosis. The angiography that recommended the revascularization procedure was used for the calculation of the Syntax II score, in order to classify the patients as low-, intermediate- or high-risk. Low- and high-risk patients were revascularized with either PCI or CABG, according to current guidelines, and were included in the subgroup S1. The second subgroup (S0) included intermediate-risk patients (Syntax II score 23–32), in whom the type of revascularization was chosen depending on the decision of the heart team or the patient preference. Patients were monitored according to the chosen mode of revascularization—PCI or CABG. LM revascularization was performed in all the patients. Clinical endpoints included cardiac death, myocardial infarction, need for revascularization and stroke. Patients were evaluated at 1 year after revascularization. Event rates were estimated using the Kaplan–Meier analysis in time to the first event. Results: At 1-year follow-up, a primary endpoint occurred in 35/95 patients in the CABG group and 37/201 in the PCI group. There were no significant differences between the 2 treatment strategies in the 1-year components of the end-point. However, a tendency to higher occurrence of cardiac death (HR = 1.48 CI (0.55–3.9), p = 0.43), necessity of repeat revascularization (HR = 1.7, CI (0.81–3.6), p = 0.16) and stroke (HR = 1.52, CI (1.15–2.93), p = 0.58) were present after CABG. Contrariwise, although without statistical significance, MI was more frequent after PCI (HR = 2, CI (0.78–5.2), p = 0.14). The Kaplan–Meier estimates in subgroups demonstrated the same tendency to higher rates for cardiac death, repeat revascularization and stroke after CABG, and higher rates of MI after PCI. Although without statistical significance, patients with an intermediate-risk showed a slightly lower risk of MACE after PCI than CABG. With the exception of dyslipidemia and gender, other cardiovascular risk factors were in favor of CABG (CKD, obesity). Conclusion: In patients with LMCS, PCI with drug-eluting stents was non-inferior to CABG with respect to the composite of cardiac death, myocardial infarction, repeat revascularization and stroke at 1 year, even in patients with intermediate Syntax II risk score. Full article

(This article belongs to the Special Issue Myocardial Infarction 2021)

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11 pages, 2726 KiB

Open AccessArticle

Association of Contemporary Statin Pretreatment Intensity and LDL-C Levels on the Incidence of STEMI Presentation

by Ziv Dadon, Mady Moriel, Zaza Iakobishvili, Elad Asher, Tal Y. Samuel, Dov Gavish, Michael Glikson and Shmuel Gottlieb

Life 2021, 11(11), 1268; https://doi.org/10.3390/life11111268 - 19 Nov 2021

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Abstract

Constituting hypolipidemic and pleiotropic effects, statins stabilize coronary artery plaque and may prevent STEMI events. This study investigated the association between contemporary statin pretreatment intensity, low-density lipoprotein cholesterol (LDL-C) levels, and the type of acute coronary syndrome (ACS) presentation: STEMI vs. NSTE-ACS. Data were drawn from the ACS Israeli Survey (ACSIS), a biennial prospective national survey that took place in 2008–2018. The rate of STEMI vs. NSTE-ACS was calculated by statin use, including statin intensity (high-intensity statin therapy (HIST) and low-intensity statin therapy (LIST) prior to the index ACS event. Among 5103 patients, 2839 (56%) were statin-naive, 1389 (27%) used LIST and 875 (17%) used HIST. Statin pretreated patients were older and had a higher rates of co-morbidities, cardiovascular disease history and pretreatment with evidence-based medications. STEMI vs. NSTE-ACS was lower among HIST vs. LIST vs. statin-naive patients (31.0%, 37.8%, and 54.0%, respectively, p for trend < 0.001). Multivariate analysis revealed that HIST was independently associated with lower STEMI presentation (OR_adj 0.70; 95% CI 0.57–0.86), while LIST (OR_adj 0.92; 95% CI 0.77–1.10) and LDL-C < 70 mg/dL (OR_adj 0.96; 95% CI 0.82–1.14) were not. In conclusion, among patients admitted with ACS, pretreatment with HIST was independently associated with a lower probability of STEMI presentation, while LIST and LDL-C < 70 mg/dL were not. Full article

(This article belongs to the Special Issue Myocardial Infarction 2021)

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11 pages, 815 KiB

Open AccessArticle

Can Fetuin A Be Utilized in the Evaluation of Elderly Patients with Acute Myocardial Infarction?

by Raluca Tomoaia, Ruxandra Ștefana Beyer, Dumitru Zdrenghea, Alexandra Dădârlat-Pop, Mircea Ioachim Popescu, Gabriel Cismaru, Gabriel Gușetu, Gyorgy Bodisz, Maria Ioana Chețan and Dana Pop

Life 2021, 11(9), 968; https://doi.org/10.3390/life11090968 - 15 Sep 2021

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Abstract

Background: Lower baseline Fetuin-A (FA) is associated with left ventricular remodeling and cardiovascular death (CVD) at 4 months after acute myocardial infarction (AMI). However, the association between FA levels, incomplete ST segment resolution (STR) following primary percutaneous coronary intervention (PCI) and early mortality in AMI has not been previously studied. Methods: We enrolled 100 patients with AMI, which we divided in two groups: 21 patients who suffered sudden cardiac death (SCD) in the first 7 days after PCI and 79 controls. We measured FA, NT-proBNP and troponin levels and correlated them with the occurrence of death in the first week after revascularization. We also tested the cut-off value of FA to determine STR at 90 min after PCI. Results: SCD was most frequently caused by pump failure (n = 10, 47.6%) and ventricular arrhythmias (n = 9, 42.5%). Plasma FA levels correlated with NT-proBNP values (r = −0.47, p = 0.04) and were significantly lower in patients presenting SCD (115 (95–175) vs. 180 (105–250) ng/mL, p = 0.03). Among all three biomarkers, FA was the only one associated with incomplete STR after PCI on the multivariate logistic regression (cut-off value of 175 ng/mL, Se = 74%, Sp = 61.1%). Death rate was highest (n = 16/55, 30%) in patients with FA levels below the cut-off value of 175 ng/mL. Conclusion: Lower FA is associated with higher early mortality and incomplete STR after primary percutaneous revascularization in patients with AMI. Measurement of FA levels in addition to NT-proBNP, troponin and STR might enable more accurate identification of high-risk patients. Full article

(This article belongs to the Special Issue Myocardial Infarction 2021)

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14 pages, 2048 KiB

Open AccessArticle

Impact of Three-Dimensional Strain on Major Adverse Cardiovascular Events after Acute Myocardial Infarction Managed by Primary Percutaneous Coronary Intervention—A Pilot Study

by Raluca Tomoaia, Ruxandra Ștefana Beyer, Dumitru Zdrenghea, Alexandra Dădârlat-Pop, Mircea Ioachim Popescu, Gabriel Cismaru, Gabriel Gușetu, Adela Mihaela Șerban, Gelu Radu Simu, Ioan Alexandru Minciună, Bogdan Caloian, Radu Roșu, Maria Ioana Chețan and Dana Pop

Life 2021, 11(9), 930; https://doi.org/10.3390/life11090930 - 07 Sep 2021

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Abstract

Background: Three-dimensional speckle-tracking echocardiography (3D-STE) allows simultaneous assessment of multidirectional components of strain. However, there are few data on its usefulness to predict prognosis in patients with acute myocardial infarction (AMI). The objective of our pilot study was to evaluate the prognostic value of four different 3D-STE parameters (global longitudinal strain (GLS-3D), global circumferential strain (GCS-3D), global radial strain (GRS-3D), and global area strain (GAS)) in AMI, after successful revascularization by primary PCI. Methods: We enrolled 94 AMI patients (66 ± 13 years, 56% men) who underwent coronary angiography. All patients had been 3D-STE assessed and followed-up for 1 year for the occurrence of MACE. Results: A total of 25 MACE were recorded over follow-up. Cut-off values of −17% for GAS (HR = 3.1, 95% CI: 1.39–6.92, p = 0.005), −12% for GCS-3D (HR = 3.06, 95% CI: 1.36–6.8, p = 0.006), −10% for GLS-3D (HR = 3.04, 95% CI: 1.36–6.78, p = 0.006), and 25% for GRS-3D (HR = 2.89, 95% CI: 1.29–6.46, p = 0.009) showed moderate accuracy in MACE prediction. Multivariate regression showed that GAS (HR = 1.1, 95% CI: 1.03–1.16), GLS-3D (HR = 1.13, 95% CI: 1.03–1.26), and GCS-3D (HR = 1.13, 95% CI: 1.03–1.23) remained independent predictors of MACE (HR = 1.07, 95% CI: 1.01–1.14 for GAS, and HR = 1.1, 95% CI: 1.01–1.2 for GCS-3D). However, post hoc power analysis indicated adequate sample size (power of 80%) only for GAS and GCS-3D for the ROC curve analysis and for GAS, GCS-3D, and GRS-3D for the log-rank test. Conclusion: Patients with AMI might benefit from early risk stratification with the aid of 3D-STE measurements, particularly GAS and GCS-3D, but larger studies are necessary to determine the optimal cut-off values to predict MACE. Full article

(This article belongs to the Special Issue Myocardial Infarction 2021)

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Review

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9 pages, 2568 KiB

Open AccessReview

Myocardial Infarction with Non-Obstructive Coronary Artery Disease: The Labyrinth of Investigations. Case Report and Review of the Literature

by Paul Simion, Bogdan Artene, Ionut Achiței, Iulian Theodor Matei, Antoniu Octavian Petriș and Nicolae-Dan Tesloianu

Life 2021, 11(11), 1181; https://doi.org/10.3390/life11111181 - 04 Nov 2021

Viewed by 2001

Abstract

Myocardial infarction with non-obstructive coronary artery disease (MINOCA) accounts for approximately 5–15% of acute myocardial infarctions (MI). This infarction type raises a series of questions about the underlying mechanism of myocardial damage, the diagnostic pathway, optimal therapy, and the outcomes of these patients when compared to MI associated with obstructive coronary artery disease. We present the case of a 60-year-old patient with multiple cardiovascular risk factors and comorbidities who is admitted in an emergency setting. The patient is known with a conservatively treated inferior myocardial infarction which occurred 3 months prior, with reduced left ventricular ejection fraction. Emergency coronary angiography revealed normal epicardial coronary arteries, which led to further investigations of the underlying cause. Considering the absence of epicardial and microvascular spasm, CMR (cardiac magnetic resonance) confirmation of two transmural myocardial infarctions in the territories tributary to coronary arteries, and a high index of myocardial resistance in culprit arteries, we concluded the diagnosis of MINOCA due to the microvascular endothelial dysfunction. Although the concept of MINOCA was devised almost a decade ago, and these patients are an important part of MI presentations, it still represents a diagnostic challenge with multiple explorations required to establish the precise etiology. Full article

(This article belongs to the Special Issue Myocardial Infarction 2021)

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19 pages, 682 KiB

Open AccessReview

Elevation Mechanisms and Diagnostic Consideration of Cardiac Troponins under Conditions Not Associated with Myocardial Infarction. Part 2

by Aleksey M. Chaulin

Life 2021, 11(11), 1175; https://doi.org/10.3390/life11111175 - 03 Nov 2021

Cited by 30 | Viewed by 2817

Abstract

This article proceeds with a discussion of the causes and mechanisms of an elevation in cardiac troponins in pathological conditions not associated with acute myocardial infarction. The second part of the article discusses the causes and mechanisms of cardiac troponins elevation in diabetes mellitus, arterial hypertension, hereditary cardiomyopathies, cardiac arrhythmias (atrial fibrillation, supraventricular tachycardia), acute aortic dissection, and diseases of the central nervous system (strokes, subarachnoidal hemorrhage). The final chapter of this article discusses in detail the false-positive causes and mechanisms of elevated cardiac troponins. Full article

(This article belongs to the Special Issue Myocardial Infarction 2021)

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24 pages, 395 KiB

Open AccessEditor’s ChoiceReview

Current Therapeutic Approach to Acute Myocardial Infarction in Patients with Congenital Hemophilia

by Minerva Codruta Badescu, Manuela Ciocoiu, Elena Rezus, Oana Viola Badulescu, Daniela Maria Tanase, Anca Ouatu, Nicoleta Dima, Ana Roxana Ganceanu-Rusu, Diana Popescu, Petronela Nicoleta Seritean Isac, Tudor-Marcel Genes and Ciprian Rezus

Life 2021, 11(10), 1072; https://doi.org/10.3390/life11101072 - 11 Oct 2021

Cited by 8 | Viewed by 2308

Abstract

Advances in the treatment of hemophilia have made the life expectancy of hemophiliacs similar to that of the general population. Physicians have begun to face age-related diseases not previously encountered in individuals with hemophilia. Treatment of acute myocardial infarction (AMI) is particularly challenging because the therapeutic strategies influence both the patient’s thrombotic and hemorrhagic risk. As progress has been made in the treatment of AMI over the last decade, we performed an in-depth analysis of the available literature, highlighting the latest advances in the therapy of AMI in hemophiliacs. It is generally accepted that after the optimal substitution therapy has been provided, patients with hemophilia should be treated in the same way as those in the general population. New-generation stents that allow short dual antiplatelet therapy and potent P2Y₁₂ receptor inhibitors have begun to be successfully used. At a time when specific recommendations and relevant data are scarce, our study provides up-to-date information to physicians involved in the treatment of AMI in hemophiliacs. Full article

(This article belongs to the Special Issue Myocardial Infarction 2021)

21 pages, 680 KiB

Open AccessReview

Current Knowledge of MicroRNAs (miRNAs) in Acute Coronary Syndrome (ACS): ST-Elevation Myocardial Infarction (STEMI)

by Daniela Maria Tanase, Evelina Maria Gosav, Anca Ouatu, Minerva Codruta Badescu, Nicoleta Dima, Ana Roxana Ganceanu-Rusu, Diana Popescu, Mariana Floria, Elena Rezus and Ciprian Rezus

Life 2021, 11(10), 1057; https://doi.org/10.3390/life11101057 - 08 Oct 2021

Cited by 7 | Viewed by 5387

Abstract

Regardless of the newly diagnostic and therapeutic advances, coronary artery disease (CAD) and more explicitly, ST-elevation myocardial infarction (STEMI), remains one of the leading causes of morbidity and mortality worldwide. Thus, early and prompt diagnosis of cardiac dysfunction is pivotal in STEMI patients for a better prognosis and outcome. In recent years, microRNAs (miRNAs) gained attention as potential biomarkers in myocardial infarction (MI) and acute coronary syndromes (ACS), as they have key roles in heart development, various cardiac processes, and act as indicators of cardiac damage. In this review, we describe the current available knowledge about cardiac miRNAs and their functions, and focus mainly on their potential use as novel circulating diagnostic and prognostic biomarkers in STEMI. Full article

(This article belongs to the Special Issue Myocardial Infarction 2021)

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12 pages, 541 KiB

Open AccessEditor’s ChoiceReview

Is There a Link between COVID-19 Infection, Periodontal Disease and Acute Myocardial Infarction?

by Ioana-Patricia Rodean, Carmen-Ioana Biriș, Vasile-Bogdan Halațiu, Andrei Modiga, Luminița Lazăr, Imre Benedek and Theodora Benedek

Life 2021, 11(10), 1050; https://doi.org/10.3390/life11101050 - 07 Oct 2021

Cited by 5 | Viewed by 2654

Abstract

Both periodontal disease and atherosclerosis are chronic disorders with an inflammatory substrate that leads to alteration of the host’s immune response. In PD, inflammation is responsible for bone tissue destruction, while in atherosclerosis, it leads to atheromatous plaque formation. These modifications result from the action of pro-inflammatory cytokines that are secreted both locally at gingival or coronary sites, and systemically. Recently, it was observed that in patients with PD or with cardiovascular disease, COVID-19 infection is prone to be more severe. While the association between PD, inflammation and cardiovascular disease is well-known, the impact of COVID-19-related inflammation on the systemic complications of these conditions has not been established yet. The purpose of this review is to bring light upon the latest advances in understanding the link between periodontal–cardiovascular diseases and COVID-19 infection. Full article

(This article belongs to the Special Issue Myocardial Infarction 2021)

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16 pages, 880 KiB

Open AccessEditor’s ChoiceReview

Elevation Mechanisms and Diagnostic Consideration of Cardiac Troponins under Conditions Not Associated with Myocardial Infarction. Part 1

by Aleksey M. Chaulin

Life 2021, 11(9), 914; https://doi.org/10.3390/life11090914 - 02 Sep 2021

Cited by 37 | Viewed by 5617

Abstract

Although cardiac troponins are considered the most specific biomarkers for the diagnosis of acute myocardial infarction (AMI), their diagnostic consideration goes far beyond the detection of this dangerous disease. The mechanisms of cardiac troponin elevation are extremely numerous and not limited to ischemic necrosis of cardiac myocytes. Practitioners should be well aware of the underlying pathological and physiological conditions that can lead to elevated serum levels of cardiac troponins to avoid differential diagnostic errors, which will be greatly increased if clinicians rely on laboratory data alone. This article presents a classification of the main causes of an elevation in cardiac troponins and discusses in detail the mechanisms of such elevation and the diagnostic consideration of cardiac troponins in some conditions not associated with AMI, such as physical exertion, inflammatory heart diseases (myocarditis and endocarditis), pulmonary embolism (PE), renal failure, and systemic inflammation (sepsis). Full article

(This article belongs to the Special Issue Myocardial Infarction 2021)

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