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Coronary Artery Disease: Risk Stratification and Optimization of Intervention Strategies
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Coronary Artery Disease: Risk Stratification and Optimization of Intervention Strategies

A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425). This special issue belongs to the section "Acquired Cardiovascular Disease".

Deadline for manuscript submissions: 31 July 2025 | Viewed by 3393

Special Issue Editor

Dr. Antonella Tommasino

E-Mail Website
Guest Editor
Cardiology Division, Sant’Andrea University Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
Interests: coronary artery disease; percutaneous coronary interventions; bifurcation lesions PCI; complex PCI; acute coronary syndromes; imaging-guided complex PCI

Special Issue Information

Dear Colleagues,

Coronary artery disease (CAD) remains one of the leading causes of death and disability worldwide, necessitating ongoing advancements in its management. The field is evolving rapidly, with technological and clinical innovations significantly enhancing diagnosis, treatment, and outcomes. However, despite these improvements, the burden of CAD remains substantial, particularly in its chronic and acute forms.

This Special Issue aims to highlight recent progress in risk stratification and intervention strategies for CAD. It will explore innovative diagnostic tools such as advanced imaging techniques. Additionally, the Issue will cover predictive models that evaluate disease progression and stratify patients based on their risk profiles. Key topics include the refinement of risk scores and predictive models for both chronic CAD and acute coronary syndromes (ACSs), enabling better identification of high-risk patients and more accurate anticipation of procedural complications.

Furthermore, this Issue will focus on optimizing intervention strategies, including recent advancements in percutaneous coronary intervention (PCI), adjunctive therapies, and protocols for minimizing complications. By addressing these critical areas, this Special Issue seeks to enhance understanding and improve clinical outcomes in CAD management for interventional cardiologists and the broader medical community.

Dr. Antonella Tommasino
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 Cardiovascular Development and Disease 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 2700 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 (CAD)
  • risk stratification
  • acute coronary syndromes (ACSs)
  • percutaneous coronary intervention (PCI)
  • predictive models
  • diagnostic imaging
  • imaging-guided complex PCI
  • adjunctive therapies
  • complication avoidance

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Published Papers (3 papers)

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Research

13 pages, 1177 KiB  
Article
High-Risk Plaque Characteristics in Patients with Suspected Stable Coronary Artery Disease and Impaired Glucose Tolerance: A Coronary Computed Tomography Angiography Study
by Thomas Rueskov Andersen, Katrine Schultz Overgaard, Laurits Juhl Heinsen, Roda Abdulkadir Mohamed, Freja Sønder Madsen, Helle Precht, Jess Lambrechtsen, Søren Auscher and Kenneth Egstrup
J. Cardiovasc. Dev. Dis. 2025, 12(2), 37; https://doi.org/10.3390/jcdd12020037 - 22 Jan 2025
Viewed by 796
Abstract
Impaired glucose tolerance (IGT), a prediabetic state, is a known risk factor for coronary artery disease (CAD). Low-attenuation plaque (LAP) lesions are associated with a high risk of coronary events. We aimed to evaluate high-risk plaque characteristics in LAP lesions between patients with [...] Read more.
Impaired glucose tolerance (IGT), a prediabetic state, is a known risk factor for coronary artery disease (CAD). Low-attenuation plaque (LAP) lesions are associated with a high risk of coronary events. We aimed to evaluate high-risk plaque characteristics in LAP lesions between patients with IGT and normal glucose tolerance (NGT) in patients suspected for stable CAD. Coronary computed tomography angiography (CCTA) identified LAP lesions and assessed plaque volumes, burdens, and high-risk plaque features. Glycemic tolerance was stratified using oral glucose tolerance tests. Among 148 patients, 202 LAP lesions were identified, with 93 patients classified as NGT and 55 as IGT. Patients with IGT had a significantly higher prevalence of LAP lesions compared with NGT (p = 0.007). LAP volume was higher in IGT (16.46 ± 12.52 mm3) compared with NGT (12.66 ± 9.72 mm3, p = 0.01), but this association did not persist in multivariate analysis. The LAP burden was greater in IGT (10.79 ± 6.84%) than NGT (8.62 ± 5.93%, p = 0.02), and the napkin-ring sign was more frequent in IGT (12%) versus NGT (5%, p = 0.02); these associations remained significant in multivariate analysis. Patients with IGT had a higher LAP burden and higher frequency of napkin-ring signs. These findings may help explain the common occurrence of prediabetes in patients with acute myocardial infarction. Full article
(This article belongs to the Special Issue Coronary Artery Disease: Risk Stratification and Optimization of Intervention Strategies)
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11 pages, 1973 KiB  
Article
Computed Tomography Coronary Angiography Is Feasible and Reliable for Proximal Coronary Segment Interpretation in Patients with Elevated Body Mass Index
by Anthony Salib, Michael Hay, Rahul Muthalaly, Timothy Abrahams, Nushrat Sultana, Raj Kanna, Ravi Rao, Akira Abe, John Bastwrous, Emma Aldous, Huong Tu, Sarang Paleri, Sheran Vasanthakumar, Alisha Patel, Rhea Nandurkar, Adam Brown, Andrew Lin and Nitesh Nerlekar
J. Cardiovasc. Dev. Dis. 2024, 11(12), 400; https://doi.org/10.3390/jcdd11120400 - 11 Dec 2024
Viewed by 939
Abstract
Computed tomography coronary angiography (CTCA) is under-utilised in detecting coronary artery disease (CAD) in obese patients due to concerns about non-evaluable testing. We hypothesise that these concerns are predominantly related to smaller and branch coronary vessels, and CTCA remains adequate for proximal segment [...] Read more.
Computed tomography coronary angiography (CTCA) is under-utilised in detecting coronary artery disease (CAD) in obese patients due to concerns about non-evaluable testing. We hypothesise that these concerns are predominantly related to smaller and branch coronary vessels, and CTCA remains adequate for proximal segment stenosis interpretation, which has significant clinical implications. This retrospective cohort study, on consecutive patients referred for CTCA for suspected CAD, grouped patients by body mass index. A 4-point Likert scale assessed image quality, with any poorly visualised segment at the per-patient level resulting in the CTCA being subsequently analysed for proximal coronary artery segment evaluability. Of the 703 patients, 93.5% of the studies were fully evaluable. Patients with a BMI ≥ 40, diabetic patients, and patients with an elevated acquisition heart rate were associated with suboptimal studies. Of the 46 suboptimal studies, 163/182 (90%) of proximal segments were fully evaluable. Non-evaluable segments were derived from seven patients (one with a BMI ≥ 40). Reasons for proximal segment non-evaluability were predominantly due to calcific blooming (12/19 segments). While CTCA may be less reliable for distal and side-branch artery evaluation in obese patients, it remains highly evaluable for stenosis severity of the proximal main coronary segments, which carries prognostic significance. It may therefore be considered a suitable non-invasive anatomic test for patients, regardless of BMI. Full article
(This article belongs to the Special Issue Coronary Artery Disease: Risk Stratification and Optimization of Intervention Strategies)
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Graphical abstract

14 pages, 2084 KiB  
Article
Comprehensive Risk Assessment of LAD Disease Progression in CCTA: The CLAP Score Study
by Antonella Tommasino, Federico Dell’Aquila, Marco Redivo, Luca Pittorino, Giulia Mattaroccia, Federica Tempestini, Stefano Santucci, Matteo Casenghi, Francesca Giovannelli, Stefano Rigattieri, Andrea Berni and Emanuele Barbato
J. Cardiovasc. Dev. Dis. 2024, 11(11), 338; https://doi.org/10.3390/jcdd11110338 - 23 Oct 2024
Viewed by 1295
Abstract
Background: a wider left main bifurcation angle (LMBA) has been linked to severe plaque development in the proximal left anterior descending artery (LAD). This study aimed to identify predictors of severe proximal LAD stenosis and major adverse cardiovascular events (MACE) using coronary computed [...] Read more.
Background: a wider left main bifurcation angle (LMBA) has been linked to severe plaque development in the proximal left anterior descending artery (LAD). This study aimed to identify predictors of severe proximal LAD stenosis and major adverse cardiovascular events (MACE) using coronary computed tomography angiography (CCTA). Methods: from an initial cohort of 650 consecutive patients, we analyzed 499 patients who met the inclusion criteria after exclusions. Plaque morphology and characteristics were assessed by CCTA, and MACE occurrences were recorded at follow-up. A predictive score for LAD disease progression (CLAP score) was developed and validated. Results: severe proximal LAD stenosis was detected in 32% (160/499) of patients by CCTA. MACE occurred in 12.5% of patients at follow-up. Significant predictors of MACE were LMBA > 80° (HR: 4.47; 95% CI: 3.80–6.70; p < 0.001), diabetes (HR: 2.94; 95% CI: 1.54–4.63; p = 0.031), chronic kidney disease (HR: 1.71; 95% CI: 1.31–6.72; p = 0.041), high-risk plaques (HR: 2.30; 95% CI: 1.45–3.64; p < 0.01), obstructive CAD (HR: 2.50; 95% CI: 1.50 to 4.10, p = 0.01), and calcium score (CAC) (HR: 1.05; 95% CI: 1.02–1.08, p = 0.004). The CLAP score demonstrated good discriminatory power in both the development (AUC 0.91; 95% CI: 0.86–0.96) and validation cohorts (AUC 0.85; 95% CI: 0.79–0.91); Conclusions: LMBA > 80°, diabetes, chronic kidney disease, obstructive CAD, CAC score >180 and high-risk plaques were significant predictors of MACE in CCTA patients. The CLAP score effectively predicted LAD disease progression, aiding in risk stratification and optimization of intervention strategies for suspected coronary artery disease. Full article
(This article belongs to the Special Issue Coronary Artery Disease: Risk Stratification and Optimization of Intervention Strategies)
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