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Exploring Acute Coronary Syndrome: Insights from Basic and Clinical Research—2nd...
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Exploring Acute Coronary Syndrome: Insights from Basic and Clinical Research—2nd Edition

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

Deadline for manuscript submissions: 20 November 2026 | Viewed by 4177

Special Issue Editor

Dr. Cristiana Bustea

E-Mail Website
Guest Editor
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
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Welcome to our Special Issue, entitled “Exploring Acute Coronary Syndrome: Insights from Basic and Clinical Research—2nd Edition”. 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 250 words) can be sent to the Editorial Office for assessment.

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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Related Special Issue

Published Papers (4 papers)

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Research

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14 pages, 1133 KB  
Article
Association of Coronary Sinus Flow with Long-Term Risk of Acute Coronary Syndrome and Composite Cardiovascular Events
by Ercan Akşit, Hasan Bozkurt and Mehmet Arslan
Biomedicines 2026, 14(4), 808; https://doi.org/10.3390/biomedicines14040808 - 2 Apr 2026
Cited by 1 | Viewed by 433
Abstract
Background/Objectives: Acute coronary syndrome (ACS) remains a leading cause of sudden cardiac death worldwide; however, limited data exist regarding the relationship between coronary arterial and coronary venous dynamics in this context. The present study aimed to evaluate whether coronary sinus flow (CSF) dynamics [...] Read more.
Background/Objectives: Acute coronary syndrome (ACS) remains a leading cause of sudden cardiac death worldwide; however, limited data exist regarding the relationship between coronary arterial and coronary venous dynamics in this context. The present study aimed to evaluate whether coronary sinus flow (CSF) dynamics obtained via transthoracic echocardiography (TTE) are associated with the long-term risk of ACS and cardiovascular events. Methods: This retrospective observational cohort study included 100 patients who underwent elective coronary angiography and had their CSF parameters assessed via TTE. All participants were followed up for a duration of up to 48 months. The primary endpoint was cardiovascular mortality, while secondary endpoints comprised the occurrence of ACS, refractory angina pectoris, and cerebrovascular events. Study endpoints were evaluated by dichotomizing the population into two groups using the median CSF value as the cutoff (low: CSF ≤ median; high: CSF > median). Results: The primary endpoint did not differ significantly between the two groups; however, refractory angina was significantly more common in the high CSF group [4 (8.2%) vs. 12 (24.5%), p = 0.029]. Similarly, the high CSF group exhibited a significantly higher rate of the composite endpoint than the low CSF group [13 (26.5%) vs. 25 (51.0%), p = 0.013]. In multivariate Cox analysis, CSF was an independent predictor of the composite endpoint (HR: 1.50; 95% CI: 1.11–2.02, p = 0.009). Conclusions: Baseline CSF measured by TTE was independently associated with the composite endpoint, whereas its association with isolated ACS was limited. CSF assessment may provide incremental prognostic information alongside conventional arterial and microvascular evaluation. Full article
(This article belongs to the Special Issue Exploring Acute Coronary Syndrome: Insights from Basic and Clinical Research—2nd Edition)
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12 pages, 3732 KB  
Article
Spatial and Functional Immune Profiling Identifies Impaired Vascular Repair in Human Myocardial Infarction
by Amankeldi A. Salybekov, Saida Shaikalamova, Aiman Kinzhebay, Markus Wolfien and Takayuki Asahara
Biomedicines 2026, 14(4), 755; https://doi.org/10.3390/biomedicines14040755 - 26 Mar 2026
Viewed by 654
Abstract
Background: In an earlier murine model of myocardial infarction (MI), we showed that CD8 cells and myeloid dendritic cells (mDCs) infiltrate the infarcted myocardium within the first week. However, in humans, the spatial interplay between CD8+ T cells and dendritic cells in [...] Read more.
Background: In an earlier murine model of myocardial infarction (MI), we showed that CD8 cells and myeloid dendritic cells (mDCs) infiltrate the infarcted myocardium within the first week. However, in humans, the spatial interplay between CD8+ T cells and dendritic cells in the spatial context of human myocardial infarction remains underexplored. Objective: In the present study, we applied spatial transcriptomics and functional assays to characterize immune–stromal dynamics in infarcted myocardium and peripheral blood. Methods & Results: Spatial transcriptomics analysis of infarcted human myocardium at days 2 and 6 post-MI, combined with peripheral blood flow cytometry and EPC colony-forming assays, was performed. Cell composition, pathway enrichment, and cell-to-cell communication analyses were conducted to map immune–stromal cells’ dynamics across time points. Spatial mapping identified dynamic shifts in immune, fibroblast, and endothelial populations, with fibroblasts and endothelial cells remaining abundant throughout. CD8+ T cells accumulated in ischemic regions while their circulating levels declined. Gene Ontology and pathway analyses of CD8A+ transcripts revealed enrichment of proinflammatory and NF-κB survival programs. ITGAX/CD33/THBD+ APCs progressively increased within infarct zones, activating antigen-presentation and leukocyte chemotaxis pathways. Early (day 2) APC–endothelial crosstalk showed the strongest predicted recruitment signals for CD8+ T cells, which diminished by day 6. Finally, EPC colony-forming capacity showed a tendency for reduction in MI patients and inversely correlated with coronary lesion burden, indicating impaired vascular repair potential. Conclusions: This integrative spatial and functional study demonstrates that APC-driven CD8+ recruitment and EPC dysfunction are key features of human MI. Immune–endothelial niches facilitate early cytotoxic T-cell infiltration, while progenitor depletion limits vascular regeneration. These findings provide mechanistic insight into immune–vascular imbalance during infarct healing and highlight potential therapeutic targets to modulate inflammation and restore vascular repair. Full article
(This article belongs to the Special Issue Exploring Acute Coronary Syndrome: Insights from Basic and Clinical Research—2nd Edition)
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Review

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21 pages, 14385 KB  
Review
The Coronary Venous System in Acute Coronary Syndrome: A Narrative Review
by Ercan Akşit, Cengiz Demir, Uğur Özpınar and Esra Duman Acar
Biomedicines 2026, 14(5), 1063; https://doi.org/10.3390/biomedicines14051063 - 7 May 2026
Viewed by 464
Abstract
Acute coronary syndrome (ACS) remains a leading cause of death and morbidity worldwide. The pathophysiology of ACS has been largely interpreted through abnormalities of the coronary arteries and the microvascular bed. However, the coronary circulation is fundamentally a closed-loop system, in which the [...] Read more.
Acute coronary syndrome (ACS) remains a leading cause of death and morbidity worldwide. The pathophysiology of ACS has been largely interpreted through abnormalities of the coronary arteries and the microvascular bed. However, the coronary circulation is fundamentally a closed-loop system, in which the venous component represents the final link in myocardial blood return. In contrast to the extensive literature on arterial and microvascular disease, there are relatively few studies on the coronary venous system (CVS) in the context of ACS. The CVS is important in relation to ACS from two complementary perspectives. First, structural or functional abnormalities of the CVS can contribute to myocardial ischemia; second, coronary venous flow can reflect the hemodynamic outcomes of acute ischemia and reperfusion. The ‘vascular waterfall’ phenomenon is considered one of the primary mechanisms governing coronary venous return, linking myocardial compression and venous pressure to the flow from the coronary sinus (CS) into the right atrium. Experimental and clinical evidence has shown that CS thrombosis is associated with myocardial infarction and may also complicate ACS. Furthermore, studies evaluating CS blood flow generally show a decrease in the acute phase of ischemia and an increase after reperfusion. However, the existing evidence is limited and largely based on small observational studies. Therefore, this review aimed to examine the pathophysiological mechanisms and hemodynamic behavior of the CVS in ACS, starting from embryological development. Full article
(This article belongs to the Special Issue Exploring Acute Coronary Syndrome: Insights from Basic and Clinical Research—2nd Edition)
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14 pages, 1032 KB  
Review
Thyrotoxicosis and the Heart: An Underrecognized Trigger of Acute Coronary Syndromes
by Larisa Anghel, Anca Diaconu, Laura-Cătălina Benchea, Cristina Prisacariu, Dragoș Viorel Scripcariu, Răzvan-Liviu Zanfirescu, Gavril-Silviu Bîrgoan, Radu Andy Sascău and Cristian Stătescu
Biomedicines 2025, 13(11), 2591; https://doi.org/10.3390/biomedicines13112591 - 23 Oct 2025
Cited by 1 | Viewed by 2116
Abstract
Background: Thyrotoxicosis is a systemic condition with well-documented cardiovascular effects, but its role as a precipitant of acute coronary syndromes (ACS) is often overlooked. This review summarizes clinical cases and original studies from the last 20 years, describing ACS triggered by thyrotoxicosis. Methods: [...] Read more.
Background: Thyrotoxicosis is a systemic condition with well-documented cardiovascular effects, but its role as a precipitant of acute coronary syndromes (ACS) is often overlooked. This review summarizes clinical cases and original studies from the last 20 years, describing ACS triggered by thyrotoxicosis. Methods: Following PRISMA 2020 guidelines, we searched PubMed, Scopus, and Embase for reports published between 2004–2025. Only case reports and original articles were included. Data extracted included demographics, ECG findings, angiography results, thyroid function, etiology of hyperthyroidism, and outcomes. Results: A total of 35 cases were identified. The mean age was in the fourth decade of life, with a female predominance (57%, 20 out of 35). More than half of the patients presented with ST-segment elevation myocardial infarction (STEMI) or STEMI equivalents (21 out of 35; 60%). Electrocardiographic abnormalities most often involved anterior or inferior leads. Coronary angiography revealed normal vessels or diffuse vasospasm in 18 cases (51%), while thrombotic occlusion was observed in 4 cases (11%), spontaneous dissection in 2 cases (6%), and myocardial bridging in 3 cases (9%). The leading cause of thyrotoxicosis was Graves’ disease (≈65%), followed by painless thyroiditis, iatrogenic causes, and gestational hyperthyroidism. Thyroid storm was reported in approximately 20% of cases and was associated with malignant ventricular arrhythmias or sudden cardiac death. Conclusions: Thyrotoxicosis should be recognized as a rare but important trigger of ACS, especially in young patients without traditional risk factors. Pathophysiological mechanisms include coronary vasospasm, increased myocardial oxygen demand, and hypercoagulability. Early recognition may prevent unnecessary revascularization and optimize outcomes through integrated endocrine and cardiac management. Full article
(This article belongs to the Special Issue Exploring Acute Coronary Syndrome: Insights from Basic and Clinical Research—2nd Edition)
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