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Personalized Risk Stratification with Diagnostic and Prognostic Relevance for Coronary Artery Disease: New Challenges and Opportunities in a New Era

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: 30 May 2025 | Viewed by 3633

Special Issue Editor

Dr. Georgios I. Tagarakis

E-Mail Website
Guest Editor
Cardiothoracic Surgery Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
Interests: cardiac sugery, coronary artery bypass-grafting, coronary artery disease, minimally-invasive cardiac surgery, thoracic surgery

Special Issue Information

Dear Colleagues,

Despite the significant advances achieved during the last decade in cardiovascular research, coronary artery disease (CAD) still remains the leading cause of mortality, accounting for a significant number of premature deaths. In the -omics era, our understanding of cardiovascular risk factors has significantly improved, while successful randomized clinical trials have led to an empowered arsenal of novel cardiovascular drugs with the potential for clinical translation in the coming years. With this evidence in mind, many researchers are conducting numerous studies to search for more effective risk stratification algorithms and efficient care pathways.This Special Issue of the Journal of Clinical Medicine will cover the following important aspects of CAD research:

  • Novel non-invasive diagnostic algorithms;
  • Novel CAD risk factors;
  • Prognostic course of CAD in patients without risk factors;
  • Pathophysiology and phenotypic expression of CAD;
  • Lipidomics, genomics, proteomics and metabolomics;
  • Cardiovascular pathology;
  • Digital pathology and CAD;
  • Artificial intelligence and CAD;
  • Pharmacological and non-pharmacological emergency treatment;
  • Cardiovascular rehabilitation.

We look forward to receiving your contributions, and to future collaborations.

Thank you for your cooperation.

Dr. Georgios I. Tagarakis
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

  • coronary artery disease
  • cardiovascular prevention
  • risk stratification
  • cardiovascular pathology

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Published Papers (3 papers)

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Research

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14 pages, 1832 KiB  
Article
Poor Mental Health Status as a Risk Factor and Prognosticator in SMuRF-Less Acute Myocardial Infarction
by Dimitrios V. Moysidis, Georgios Giannopoulos, Vasileios Anastasiou, Stylianos Daios, Andreas S. Papazoglou, Alexandros C. Liatsos, Efstathios Spyridonidis, Vasileios Kamperidis, Matthaios Didagelos, Georgios Tagarakis, Christos Savopoulos, Panagiotis Kyriakidis, Sonia Konstantinidou, George Giannakoulas, Vassilios Vassilikos and Antonios Ziakas
J. Clin. Med. 2025, 14(8), 2645; https://doi.org/10.3390/jcm14082645 - 11 Apr 2025
Viewed by 324
Abstract
Background: The etiology of acute myocardial infarction (AMI) in patients without history of standard modifiable risk factors (SMuRFs) remains unclear. Simultaneously, evidence suggests that mental health status (MHS) contributes to the pathogenesis of AMI and worsens its outcomes. Methods: This analysis of the [...] Read more.
Background: The etiology of acute myocardial infarction (AMI) in patients without history of standard modifiable risk factors (SMuRFs) remains unclear. Simultaneously, evidence suggests that mental health status (MHS) contributes to the pathogenesis of AMI and worsens its outcomes. Methods: This analysis of the prospective “Beyond-SMuRFs” (NCT05535582) study included 650 consecutive patients with AMI who had available data on self-reported MHS before AMI, calculated by the SF36-Questionnaire mental component summary (MCS). Poor MHS was defined as MCS ≤ 50. Multivariable logistic-regression and Cox-regression analyses were implemented to investigate poor MHS as a potential predictor of SMuRF-less AMIs and compare all-cause mortality based on SMuRF-less and MH status, respectively. Results: Of 650 patients with AMI (mean age 62.6 ± 12.1 years), 288 (44.3%) had MCS ≤ 50 and 128 (19.7%) were SMuRF-less patients. Three out of four SMuRF-less patients reported an MCS ≤ 50 (n = 96, 75%), a significantly higher percentage than the corresponding percentage in patients with SMuRFs (n = 192, 36.8%; p < 0.01). The multivariable logistic regression model showed that MCS ≤ 50 was an independent predictor of SMuRF-less AMI [aOR = 0.95; 95% CI (0.94–0.96)]. Time-to-event analysis for all-cause mortality showed that patients with MCS > 50 had lower mortality rates than those with poor MHS (aHR, 3.61 [95% CI, 2.02 to 6.43], p < 0.01). Higher risk for all-cause mortality was also observed in SMuRF-less patients with poor MHS compared to patients with at least one SMuRF and good MHS [aHR, 4.52 (95% CI, 0.94–21.73)]. Conclusions: Poor MHS was an independent predictor of the occurrence of SMuRF-less AMI and predictive of higher mortality in patients with and without SMuRFs. Full article
(This article belongs to the Special Issue Personalized Risk Stratification with Diagnostic and Prognostic Relevance for Coronary Artery Disease: New Challenges and Opportunities in a New Era)
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15 pages, 4089 KiB  
Article
Medium- and Long-Term Outcomes of 597 Patients Following Minimally Invasive Multi-Vessel Coronary Off-Pump Bypass Surgery
by Magdalena I. Rufa, Adrian Ursulescu, Samir Ahad, Ragi Nagib, Marc Albert, Mihnea Ghinescu, Tunjay Shavahatli, Rafael Ayala, Nora Göbel, Ulrich F. W. Franke and Bartosz Rylski
J. Clin. Med. 2025, 14(5), 1707; https://doi.org/10.3390/jcm14051707 - 3 Mar 2025
Viewed by 671
Abstract
Background: Minimally invasive multi-vessel off-pump coronary artery bypass grafting (MICS CABG) through left anterior mini-thoracotomy avoids both extracorporeal circulation and sternotomy and is a very elegant, safe, and effective surgical technique, despite its still-limited adoption in the daily toolkit of cardiac surgeons. The [...] Read more.
Background: Minimally invasive multi-vessel off-pump coronary artery bypass grafting (MICS CABG) through left anterior mini-thoracotomy avoids both extracorporeal circulation and sternotomy and is a very elegant, safe, and effective surgical technique, despite its still-limited adoption in the daily toolkit of cardiac surgeons. The goal of this retrospective, single-centre analysis was to evaluate the long-term outcomes of a large patient cohort undergoing MICS CABG. Methods: This study identified 597 consecutive MICS CABG patients from August 2008 to November 2020. We obtained follow-up data by phone or mail. Every patient had a left internal thoracic artery bypass graft. The second and possibly third grafts were radial arteries, great saphenous vein segments, or right internal thoracic arteries. Results: The median age was 69 years, and 92.1% were male. The median EuroSCORE II was 1.5. There were eight conversions to sternotomy and none to cardiopulmonary bypass. The total arterial revascularisation was 92.5%, with 90.3% complete. The 30-day mortality was 0.5%. A total of 575 patients (95.8%) were tracked for 8 years on average. A Cox regression analysis found that a left ventricular ejection fraction < 50%, peripheral vascular disease, chronic kidney disease, and a history of cerebrovascular accident independently predicted severe adverse cardiac and cerebrovascular events and late death. The actuarial survival rates for one, three, five, eight, and ten years were 99%, 95%, 91%, 85%, and 80%, respectively. Conclusions: In our study group, the technique of MICS CABG has been proven to be a safe and effective surgical revascularisation method, with a low rate of early complications and favourable long-term outcomes in eligible patients. Full article
(This article belongs to the Special Issue Personalized Risk Stratification with Diagnostic and Prognostic Relevance for Coronary Artery Disease: New Challenges and Opportunities in a New Era)
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Review

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24 pages, 3568 KiB  
Review
Intersections and Challenges in the Management of Acute Coronary Syndrome and Stroke: Pathophysiology, Treatment Dilemmas, and Integrated Prevention Strategies
by Maria Cristina Carella, Eugenio Carulli, Francesco Loizzi, Simona Quarta, Alessandra Freda, Paolo Basile, Fabio Amati, Marco Maria Dicorato, Michele Davide Latorre, Maria Ludovica Naccarati, Cosimo Daniele Lenoci, Sebastiano Cicco, Gianluca Pontone, Cinzia Forleo, Andrea Igoren Guaricci, Marco Matteo Ciccone and Vincenzo Ezio Santobuono
J. Clin. Med. 2025, 14(7), 2354; https://doi.org/10.3390/jcm14072354 - 29 Mar 2025
Viewed by 2130
Abstract
Acute coronary syndrome (ACS) and stroke are interconnected conditions that often share risk factors such as atherosclerosis, thrombosis, and systemic inflammation. When these events occur simultaneously, they present unique diagnostic and therapeutic challenges. This review explores the pathophysiological mechanisms linking ACS and stroke, [...] Read more.
Acute coronary syndrome (ACS) and stroke are interconnected conditions that often share risk factors such as atherosclerosis, thrombosis, and systemic inflammation. When these events occur simultaneously, they present unique diagnostic and therapeutic challenges. This review explores the pathophysiological mechanisms linking ACS and stroke, including common pathways like plaque instability, cardioembolism, and endothelial dysfunction, while highlighting the distinct features of ischemic and hemorrhagic strokes. The manuscript provides an overview of diagnostic strategies, emphasizing the role of biomarkers, advanced neuroimaging, and risk stratification tools in guiding acute management. Furthermore, the review delves into treatment approach, emphasizing the need to balance reperfusion therapies for ACS with thrombolysis or thrombectomy for ischemic stroke while carefully managing the challenges posed by anticoagulation in cases complicated by bleeding. Long-term strategies for secondary prevention are examined, including antithrombotic regimens tailored to the dual risk of thrombosis and bleeding, as well as lipid-lowering and blood pressure management. Future perspectives highlight the potential of novel pharmacological agents, neuroprotective therapies, and AI-driven tools to enhance patient outcomes. This review underscores the importance of integrated, multidisciplinary care and identifies key areas for future research to optimize the management of these high-risk patients. Full article
(This article belongs to the Special Issue Personalized Risk Stratification with Diagnostic and Prognostic Relevance for Coronary Artery Disease: New Challenges and Opportunities in a New Era)
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