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A special issue of Biomedicines (ISSN 2227-9059). This special issue belongs to the section "Molecular and Translational Medicine".

Deadline for manuscript submissions: 31 July 2025 | Viewed by 21424

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Dr. Cristiana Bustea

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Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
Interests: hypertension; clinical cardiology; heart failure; echocardiography; myocardial infarction; atherosclerosis; blood pressure; atrial fibrillation
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Special Issue Information

Dear Colleagues,

Welcome to our Special Issue, ‘Exploring Acute Coronary Syndrome: Insights from Basic and Clinical Research’. Acute coronary syndrome (ACS) is a critical cardiovascular condition encompassing unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). As a leading cause of morbidity and mortality worldwide, ACS demands an intricate understanding of its pathophysiology, risk factors, and evolving therapeutic approaches. This Special Issue aims to delve into the realms of basic and clinical research, offering a comprehensive exploration of ACS.

Through its collection of articles, this Special Issue aspires to illuminate the latest breakthroughs and critical findings that bridge the gap between fundamental research and clinical applications. Our aim is to provide unique perspectives on diagnostic modalities, novel therapeutic interventions, and emerging trends in ACS management. By fostering collaboration and disseminating knowledge, we hope to advance the field, providing clinicians, researchers, and healthcare professionals with valuable insights that can directly impact patient outcomes.

Join us on this enlightening journey by submitting manuscripts including original studies and reviews that will unravel the complexities of ACS and will improve our understanding and management of this significant cardiovascular challenge.

Dr. Cristiana Bustea
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. Biomedicines 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

acute coronary syndrome
cardiovascular morbidity
myocardial infarction
pathophysiology
diagnostic modalities
therapeutic interventions
translational research

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Published Papers (10 papers)

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Research

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13 pages, 2424 KiB

Open AccessArticle

The Development of a Nomogram Predictive Model for Intracardiac Thrombosis Risk: A Study Based on Risk Factors in Patients with Acute Myocardial Infarction

by Xiaowei Huo, Zizhu Lian, Peizhu Dang and Yongjian Zhang

Biomedicines 2025, 13(3), 679; https://doi.org/10.3390/biomedicines13030679 - 10 Mar 2025

Viewed by 519

Abstract

Background/Objectives: Intracardiac thrombosis (ICT) is a serious complication in acute myocardial infarction (AMI) patients. This study aimed to identify potential risk factors of ICT in AMI patients, providing valuable insights for clinical management. Methods: A case–control study was conducted involving consecutive AMI patients admitted to the First Affiliated Hospital of Xi’an Jiaotong University between January 2019 and December 2022. Binary logistic regression identified independent risk factors of ICT and a nomogram prediction model was constructed and validated for accuracy. Conclusions: A total of 7341 patients with ICT and 74 without ICT were included. Multivariate logistic regression identified male gender, acute anterior wall myocardial infarction (AWMI), ventricular aneurysm, and lower prothrombin activity as independent risk factors of ICT in AMI patients. A nomogram based on these factors demonstrated excellent performance (AUC: 0.910, 95% CI: 0.877–0.943, p < 0.001), with calibration and sensitivity analyses confirming its robustness. This nomogram provides an accurate tool for predicting ICT risk, facilitating personalized management and early intervention in AMI patients. Full article

(This article belongs to the Special Issue Exploring Acute Coronary Syndrome: Insights from Basic and Clinical Research)

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15 pages, 2026 KiB

Open AccessArticle

Nomogram Predicting In-Hospital Mortality in Patients with Myocardial Infarction Treated with Primary Coronary Interventions Based on Logistic and Angiographic Predictors

by Lukasz Gawinski, Anna Milewska, Michal Marczak and Remigiusz Kozlowski

Biomedicines 2025, 13(3), 646; https://doi.org/10.3390/biomedicines13030646 - 6 Mar 2025

Viewed by 457

Abstract

Background: Systems developed in recent years to assess the risk of in-hospital death in patients with myocardial infarction (MI) are mainly based on angiographic, electrocardiographic, and laboratory variables. Risk systems based on contemporary angiographic data and logistic variables have not been reported. The aim of this study was to develop and validate a system to assess the risk of in-hospital death in patients across the entire clinical spectrum of MI treated with primary coronary intervention (PCI) based on modern angiographic and logistic predictors. Methods: A subgroup of patients from the observational single-centre registry of MI treated with PCIs (from 1 February 2019 until 31 January 2020) was used to develop a multivariate logistic regression model predicting in-hospital mortality. The population (603 patients) was divided, with 60% of the sample used for model derivation and the remaining 40% used for internal model validation. Results: The main findings were as follows: (1) coronary angiography results and suboptimal flow after PCI were important predictors of in-hospital mortality; (2) the time of PCI as well as the mode of presentation of patients with MI contributed to in-hospital mortality; and (3) the discrimination (C statistic = 0.848, 95% CI: [0.765, 0.857]) and calibration (χ² = 2.78, pHL = 0.94) were good in the derivation set, while the discrimination (C statistic = 0.6438, 95% CI: [0.580, 0.703]) in the validation set was satisfactory. Conclusions: A novel clinical nomogram based on four available logistic and angiographic variables was developed and validated for in-hospital mortality after PCIs in a wide range of MIs. Full article

(This article belongs to the Special Issue Exploring Acute Coronary Syndrome: Insights from Basic and Clinical Research)

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13 pages, 2447 KiB

Open AccessArticle

Targeting Inflammation with Galectin-3 and PIIINP Modulation Among ST-Segment Elevation Acute Coronary Syndrome Patients Underwent Delayed Percutaneous Coronary Intervention

by Saskia Dyah Handari, Mohammad Saifur Rohman, Djanggan Sargowo, Aulanni’am, Dahliatul Qosimah, Bayu Lestari and Ricardo Adrian Nugraha

Biomedicines 2025, 13(2), 259; https://doi.org/10.3390/biomedicines13020259 - 21 Jan 2025

Cited by 1 | Viewed by 1074

Abstract

Background/Objectives: ST-segment elevation acute coronary syndrome (STE-ACS) represents a significant global health challenge, with cardiac remodeling and fibrosis critically affecting recovery after percutaneous coronary intervention (PCI). Colchicine, known for its anti-inflammatory effects, may regulate key fibrotic markers such as Procollagen III N-terminal Propeptide (PIIINP) and Galectin-3. This study assesses colchicine’s effect on these biomarkers in STE-ACS patients undergoing delayed PCI. Methods: In this multicenter, randomized, double-blind trial, we examined colchicine’s impact on Galectin-3 and PIIINP in 164 STE-ACS patients undergoing early or delayed PCI. Patients received colchicine shortly after hospital admission. Biomarker changes were evaluated at 24 h and five days post-treatment using two-way ANOVA. Results: Clinical trials in the early PCI group revealed that Galectin-3 levels decreased significantly on day one (p < 0.01) and further on day five (p < 0.0001), indicating Primary PCI has benefits to inhibition of fibrosis beyond colchicine add-on treatment. But, in the delayed PCI group, Galectin-3 levels significantly increased on day one (p < 0.01), but the decrease observed by day five was not statistically significant. It is related that the benefits of colchicine treatment may exceed PCI implantation in preventing cardiac remodeling. In the delayed PCI group, PIIINP levels showed a significant reduction on day five (p < 0.0001). Conclusions: This Colchicine demonstrates novel efficacy in delayed PCI, with a significant increase in Galectin-3 and a sharp reduction in PIIINP, indicating its ability to control fibrosis. This positions colchicine as a breakthrough therapy for improving outcomes in STE-ACS patients with delayed intervention. Full article

(This article belongs to the Special Issue Exploring Acute Coronary Syndrome: Insights from Basic and Clinical Research)

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14 pages, 617 KiB

Open AccessArticle

Associations of the CYP7A1 Gene Polymorphisms Located in the Promoter and Enhancer Regions with the Risk of Acute Coronary Syndrome, Plasma Cholesterol, and the Incidence of Diabetes

by Gilberto Vargas-Alarcón, Óscar Pérez-Méndez, Rosalinda Posadas-Sánchez, Héctor González-Pacheco, María Luna-Luna, Galileo Escobedo and José Manuel Fragoso

Biomedicines 2024, 12(3), 617; https://doi.org/10.3390/biomedicines12030617 - 9 Mar 2024

Cited by 2 | Viewed by 1857

Abstract

Cholesterol-7-alpha hydroxylase (CYP7A1) is a key enzyme in the synthesis of bile salts, and its activity can contribute to determining cholesterol levels and, consequently, the risk of developing coronary atherosclerotic disease. We evaluated whether seven (rs3808607 G/T, rs9297994 G/A, rs10504255 A/G, rs8192870 G/T, rs2081687 C/T, rs1457043 C/T, and rs10107182 C/T) polymorphisms located in the promoter and enhancer regions of the CYP7A1 gene, which have not been sufficiently explored, are candidates of risk markers of acute coronary syndrome (ACS) in the Mexican population. These polymorphisms were determined in a group of 1317 patients with ACS and 1046 control subjects. The results showed that, under different inheritance models, the alleles rs9297994 G, rs10504255 G, rs8192870 T, rs2081687 T, and rs10107182 C were significantly associated with an increased risk of ACS (pC < 0.05). In addition, the incidence of dyslipidemia among patients with ACS, notably high total cholesterol and LDL-cholesterol, and low HDL-cholesterol plasma levels, were more frequent in carriers of the same five risk alleles associated with ACS (p < 0.05). There was also an unexpected increased incidence of type 2 diabetes mellitus (T2DM) in patients with ACS who are homozygous for the rs2081687 T, rs9297944 G, rs10504255 G, and rs10107182 C alleles of the CYP7A1 gene, suggesting that such gene variants enhance the development of coronary complications in patients with diabetes (p < 0.05). In summary, our study demonstrated that five polymorphisms situated in the promoter and enhancer regions of the CYP7A1 gene are associated with the risk of ACS and higher incidences of dyslipidemia and T2DM in Mexican patients with ACS. Full article

(This article belongs to the Special Issue Exploring Acute Coronary Syndrome: Insights from Basic and Clinical Research)

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Review

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23 pages, 1590 KiB

Open AccessReview

Coronary Microvascular Disease Early After Myocardial Infarction: Diagnostic Approach and Prognostic Value—A Narrative Review

by Stefanos Sokratous, Andreas Mitsis, Elina Khattab, Dimitrios Karelas, Nikolaos Velidakis and Nikolaos P. E. Kadoglou

Biomedicines 2025, 13(6), 1289; https://doi.org/10.3390/biomedicines13061289 - 23 May 2025

Viewed by 408

Abstract

Coronary microvascular disease (CMVD) is not an uncommon complication after acute myocardial infarction (AMI), independent of prompt revascularization. It is a serious yet underdiagnosed disease that has a major impact on patient outcomes. Even when the infarct-related artery is successfully revascularized, a significant percentage of patients still have compromised microvascular circulation, which is linked to higher cardiovascular mortality and hospitalization for heart failure. The well-known invasive methods, such as the index of microvascular resistance (IMR) and the coronary flow reserve (CFR), have been considered as gold standards. However, they are constrained by their hazards and complexity. Non-invasive techniques, such as echocardiography Doppler for CFR assessment, positron emission tomography (PET), cardiac magnetic resonance imaging (CMR), and some other techniques provide alternatives, but their accessibility, cost and implementation during the peri-AMI period raise obstacles to their wider use. This review highlights both invasive and non-invasive modalities as it examines the diagnostic methods and prognostic significance of CMVD development early after AMI. Enhancing long-term results in this high-risk population requires a thorough understanding of pathophysiology and a commitment to larger diagnostic and prognostic studies for CMVD. Full article

(This article belongs to the Special Issue Exploring Acute Coronary Syndrome: Insights from Basic and Clinical Research)

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25 pages, 1132 KiB

Open AccessReview

MINOCA: A Pathophysiological Approach of Diagnosis and Treatment—A Narrative Review

by Elina Khattab, Dimitrios Karelas, Theofilos Pallas, Panagiotis Kostakis, Constantinos H. Papadopoulos, Skevos Sideris, Nikolaos Patsourakos and Nikolaos P. E. Kadoglou

Biomedicines 2024, 12(11), 2457; https://doi.org/10.3390/biomedicines12112457 - 25 Oct 2024

Cited by 4 | Viewed by 2482

Abstract

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a clinical entity characterized by the absence of significant coronary artery obstruction in epicardial arteries (<50%) on coronary angiography in the setting of acute myocardial infarction (AMI). This article aims to provide a narrative review of the pathophysiological mechanisms, diagnostic challenges, and prognosis associated with MINOCA based on pathophysiology regarding the atherosclerotic and non-atherosclerotic causes. Etiological factors, including thromboembolism, coronary artery spasm, spontaneous coronary artery dissection, coronary microvascular disease, and supply–demand mismatch, are addressed. Imaging modalities such as echocardiography, advances in coronary angiography like intravascular ultrasound (IVUS) and optical coherence tomography (OCT), cardiac magnetic resonance (CMR), and coronary computed tomography angiography (CCTA) are also analyzed. MINOCA patients have a better short-term prognosis compared to those with obstructive coronary artery disease but face significant long-term risks, underscoring the need for precise diagnosis and management strategies. Elevated inflammatory markers and specific genetic predispositions are also associated with adverse outcomes in MINOCA. This review focused on MINOCA from a pathophysiological perspective on the diverse underlying mechanisms, the challenges in achieving accurate diagnosis, the importance of a tailored therapeutic approach and the necessity for further investigation of clinical outcomes. Full article

(This article belongs to the Special Issue Exploring Acute Coronary Syndrome: Insights from Basic and Clinical Research)

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19 pages, 2598 KiB

Open AccessReview

The Role of Inflammation in the Pathogenesis of Cardiogenic Shock Secondary to Acute Myocardial Infarction: A Narrative Review

by Irina Kologrivova, Maria Kercheva, Oleg Panteleev and Vyacheslav Ryabov

Biomedicines 2024, 12(9), 2073; https://doi.org/10.3390/biomedicines12092073 - 11 Sep 2024

Cited by 4 | Viewed by 3291

Abstract

Cardiogenic shock (CS) is one of the most serious complications of myocardial infarction (MI) with a high mortality rate. The timely and effective prevention and early suppression of this adverse event may influence the prognosis and outcome in patients with MI complicated by CS (MI CS). Despite the use of existing pharmaco-invasive options for maintaining an optimal pumping function of the heart in patients with MI CS, its mortality remains high, prompting the search for new approaches to pathogenetic therapy. This review considers the role of the systemic inflammatory response in the pathogenesis of MI CS. The primary processes involved in its initiation are described, including the progression from the onset of MI to the generalization of the inflammatory response and the development of multiple organ dysfunction. The approaches to anti-inflammatory therapy in patients with CS are discussed, and further promising research directions are outlined. In this review, we updated and summarized information on the inflammatory component of MI CS pathogenesis with a particular focus on its foundational aspects. This will facilitate the identification of specific inflammatory phenotypes and endotypes in MI CS and the development of targeted therapeutic strategies for this MI complication. Full article

(This article belongs to the Special Issue Exploring Acute Coronary Syndrome: Insights from Basic and Clinical Research)

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30 pages, 2914 KiB

Open AccessReview

Current and Future Roles of Glycoprotein IIb–IIIa Inhibitors in Primary Angioplasty for ST-Segment Elevation Myocardial Infarction

by Giuseppe De Luca, Ashley Verburg, Arnoud van’t Hof, Jurrien ten Berg, Dean J. Kereiakes, Barry S. Coller and Charles Michael Gibson

Biomedicines 2024, 12(9), 2023; https://doi.org/10.3390/biomedicines12092023 - 4 Sep 2024

Cited by 2 | Viewed by 2504

Abstract

Acute myocardial infarction still represents the major cause of mortality in high-income countries. Therefore, considerable efforts have been focused on the treatment of myocardial infarctions in the acute and long-term phase, with special attention being paid to reperfusion strategies and adjunctive antithrombotic therapies. In fact, despite the successful mechanical recanalization of the epicardial conduit, a substantial percentage of patients still experience poor myocardial reperfusion or acute/subacute in-stent thrombosis. Due the delayed onset of action of currently available oral antiplatelet therapies, glycoprotein (GP) IIb–IIIa inhibitors could be expected to improve clinical outcomes, especially when administrated in the early phase of the infarction, due to the larger platelet composition of fresh thrombi, the dynamic nature of early thrombi, and the larger amount of viable myocardium existing in the early, as compared to a delayed, phase. Considerable evidence has accumulated regarding the benefits from GP IIb–IIIa inhibitors on mortality, especially among high-risk patients and when administered as an upstream strategy. Therefore, based on currently available data, GP IIb–IIIa inhibitors can be considered when the drug can be administered within the first 3 h of symptom onset and among high-risk patients (e.g., those with advanced Killip class or an anterior myocardial infarction). Even though it is not universally accepted, in our opinion, this strategy should be implemented in a pre-hospital setting (in an ambulance) or as soon as possible when arriving at the hospital (at the Emergency Room or Coronary Care Unit, irrespective of whether they are in spoke or hub hospitals). A new, second-generation GP IIb–IIIa inhibitor (zalunfiban) appears to be highly suitable as a pre-hospital pharmacological facilitation strategy at the time of first medical contact due to its favourable features, including its simple subcutaneous administration, rapid onset of action (15 min), and limited time of action (with a half-life of ~1 h), which is likely to minimize the risk of bleeding. The ongoing CELEBRATE trial, including 2499 STEMI patients, may potentially provide compelling data to support the upstream treatment of STEMI patients undergoing mechanical reperfusion. In fact, although the current therapeutic target of increased rates of timely reperfusion has been achieved, the future goal in myocardial infarction treatment should be to achieve the most rapid reperfusion prior to primary percutaneous coronary intervention, thus further minimizing myocardial damage, or, in some cases, even preventing it completely, and improving survival. Full article

(This article belongs to the Special Issue Exploring Acute Coronary Syndrome: Insights from Basic and Clinical Research)

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16 pages, 1224 KiB

Open AccessReview

Current Management of Non-ST-Segment Elevation Acute Coronary Syndrome

by Pablo Díez-Villanueva, César Jiménez-Méndez, Pedro Cepas-Guillén, Andrea Arenas-Loriente, Ignacio Fernández-Herrero, Héctor García-Pardo and Felipe Díez-Delhoyo

Biomedicines 2024, 12(8), 1736; https://doi.org/10.3390/biomedicines12081736 - 2 Aug 2024

Cited by 1 | Viewed by 4875

Abstract

Cardiovascular disease constitutes the leading cause of morbimortality worldwide. Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is a common cardiovascular condition, closely related to the ageing population and significantly affecting survival and quality of life. The management of NSTE-ACS requires specific diagnosis and therapeutic strategies, thus highlighting the importance of a personalized approach, including tailored antithrombotic therapies and regimens, combined with timely invasive management. Moreover, specific and frequent populations in clinical practice, such as the elderly and those with chronic kidney disease, pose unique challenges in the management of NSTE-ACS due to their increased risk of ischemic and hemorrhagic complications. In this scenario, comprehensive management strategies and multidisciplinary care are of great importance. Cardiac rehabilitation and optimal management of cardiovascular risk factors are essential elements of secondary prevention since they significantly improve prognosis. This review highlights the need for a personalized approach in the management of NSTE-ACS, especially in vulnerable populations, and emphasizes the importance of precise antithrombotic management together with tailored revascularization strategies, as well as the role of cardiac rehabilitation in NSTE-ACS patients. Full article

(This article belongs to the Special Issue Exploring Acute Coronary Syndrome: Insights from Basic and Clinical Research)

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20 pages, 519 KiB

Open AccessReview

Emerging Therapeutic Targets for Acute Coronary Syndromes: Novel Advancements and Future Directions

by Andreas Mitsis, Michael Myrianthefs, Stefanos Sokratous, Georgia Karmioti, Michaela Kyriakou, Michail Drakomathioulakis, Stergios Tzikas, Nikolaos P. E. Kadoglou, Efstratios Karagiannidis, Athina Nasoufidou, Nikolaos Fragakis, Antonios Ziakas and George Kassimis

Biomedicines 2024, 12(8), 1670; https://doi.org/10.3390/biomedicines12081670 - 26 Jul 2024

Cited by 5 | Viewed by 2923

Abstract

Acute coronary syndrome (ACS) remains a major cause of morbidity and mortality worldwide, requiring ongoing efforts to identify novel therapeutic targets to improve patient outcomes. This manuscript reviews promising therapeutic targets for ACS identified through preclinical research, including novel antiplatelet agents, anti-inflammatory drugs, and agents targeting plaque stabilization. Preclinical studies have expounded these agents’ efficacy and safety profiles in mitigating key pathophysiological processes underlying ACS, such as platelet activation, inflammation, and plaque instability. Furthermore, ongoing clinical trials are evaluating the efficacy and safety of these agents in ACS patients, with potential implications for optimizing ACS management. Challenges associated with translating preclinical findings into clinical practice, including patient heterogeneity and trial design considerations, are also discussed. Overall, the exploration of emerging therapeutic targets offers promising avenues for advancing ACS treatment strategies and improving patient outcomes. Full article

(This article belongs to the Special Issue Exploring Acute Coronary Syndrome: Insights from Basic and Clinical Research)

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