Journal of Clinical Medicine

Editorial

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6 pages, 196 KiB

Open AccessEditorial

Looking Back, Leaning Forward—A Contemporary Overview of Acute Coronary Syndrome

by Alexander Fardman, Fernando Chernomordik and Roy Beigel

J. Clin. Med. 2024, 13(23), 7331; https://doi.org/10.3390/jcm13237331 - 2 Dec 2024

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Abstract

Cardiovascular disease (CVD) remains the most common cause of morbidity and mortality worldwide [...] Full article

(This article belongs to the Special Issue Acute Coronary Syndrome: Current State of Diagnosis and Treatment)

Research

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13 pages, 1030 KiB

Open AccessArticle

The Role of Pan-Immune-Inflammation Value in Determining the Severity of Coronary Artery Disease in NSTEMI Patients

by Zeki Cetinkaya, Saban Kelesoglu, Aydin Tuncay, Yucel Yilmaz, Yucel Karaca, Mehdi Karasu, Ozlem Secen, Ahmet Cinar, Murat Harman, Seyda Sahin, Yusuf Akin and Ozkan Yavcin

J. Clin. Med. 2024, 13(5), 1295; https://doi.org/10.3390/jcm13051295 - 25 Feb 2024

Cited by 16 | Viewed by 1866

Abstract

Background: Even though medication and interventional therapy have improved the death rate for non-ST elevation myocardial infarction (NSTEMI) patients, these patients still have a substantial residual risk of cardiovascular events. Early identification of high-risk individuals is critical for improving prognosis, especially in this [...] Read more.

Background: Even though medication and interventional therapy have improved the death rate for non-ST elevation myocardial infarction (NSTEMI) patients, these patients still have a substantial residual risk of cardiovascular events. Early identification of high-risk individuals is critical for improving prognosis, especially in this patient group. The focus of recent research has switched to finding new related indicators that can help distinguish high-risk patients. For this purpose, we examined the relationship between the pan-immune-inflammation value (PIV) and the severity of coronary artery disease (CAD) defined by the SYNTAX score (SxS) in NSTEMI patients. Methods: Based on the SxS, CAD patients were split into three groups. To evaluate the risk variables of CAD, multivariate logistic analysis was employed. Results: The PIV (odds ratio: 1.003; 95% CI: 1.001–1.005; p = 0.005) was found to be an independent predictor of a high SxS in the multivariate logistic regression analysis. Additionally, there was a positive association between the PIV and SxS (r: 0.68; p < 0.001). The PIV predicted the severe coronary lesion in the receiver-operating characteristic curve analysis with a sensitivity of 91% and specificity of 81.1%, using an appropriate cutoff value of 568.2. Conclusions: In patients with non-STEMI, the PIV, a cheap and easily measured laboratory variable, was substantially correlated with a high SxS and the severity of CAD. Full article

(This article belongs to the Special Issue Acute Coronary Syndrome: Current State of Diagnosis and Treatment)

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11 pages, 873 KiB

Open AccessArticle

The Impact of Sex on Cardiogenic Shock Outcomes Following ST Elevation Myocardial Infarction

by Joshua H. Arnold, Leor Perl, Abid Assali, Pablo Codner, Gabriel Greenberg, Abid Samara, Avital Porter, Katia Orvin, Ran Kornowski and Hana Vaknin Assa

J. Clin. Med. 2023, 12(19), 6259; https://doi.org/10.3390/jcm12196259 - 28 Sep 2023

Cited by 4 | Viewed by 1285

Abstract

Background: Cardiogenic shock (CS) remains the leading cause of ST elevation myocardial infarction (STEMI)-related mortality. Contemporary studies have shown no sex-related differences in mortality. Methods: STEMI-CS patients undergoing primary percutaneous coronary intervention (PPCI) were included based on a dedicated prospective STEMI database. We [...] Read more.

Background: Cardiogenic shock (CS) remains the leading cause of ST elevation myocardial infarction (STEMI)-related mortality. Contemporary studies have shown no sex-related differences in mortality. Methods: STEMI-CS patients undergoing primary percutaneous coronary intervention (PPCI) were included based on a dedicated prospective STEMI database. We compared sex-specific differences in CS characteristics at baseline, during hospitalization, and in subsequent clinical outcomes. Endpoints included all-cause mortality and major adverse cardiac events (MACE). Results: Of 3202 consecutive STEMI patients, 210 (6.5%) had CS, of which 63 (30.0%) were women. Women were older than men (73.2 vs. 65.5% y, p < 0.01), and more had hypertension (68.3 vs. 52.8%, p = 0.019) and diabetes (38.7 vs. 24.8%, p = 0.047). Fewer were smokers (13.3 vs. 41.2%, p < 0.01), had previous PCI (9.1 vs. 22.3% p = 0.016), or required IABP (35.3 vs. 51.1% p = 0.027). Women had higher rates of mortality (53.2 vs. 35.3% in-hospital, p = 0.01; 61.3 vs. 41.9% at 1 month, p = 0.01; and 73.8 vs. 52.6% at 3 years, p = 0.05) and MACE (60.6 vs. 41.6% in-hospital, p = 0.032; 66.1 vs. 45.6% at 1 month, p = 0.007; and 62.9 vs. 80.3% at 3 years, p = 0.015). After multivariate adjustment, female sex remained an independent factor for death (HR-2.42 [95% CI 1.014–5.033], p = 0.042) and MACE (HR-1.91 [95% CI 1.217–3.031], p = 0.01). Conclusions: CS complicating STEMI is associated with greater short- and long-term mortality and MACE in women. Sex-focused measures to improve diagnosis and treatment are mandatory for CS patients. Full article

(This article belongs to the Special Issue Acute Coronary Syndrome: Current State of Diagnosis and Treatment)

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Review

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23 pages, 2136 KiB

Open AccessReview

Precision Medicine in Acute Coronary Syndromes

by Andrea Caffè, Francesco Maria Animati, Giulia Iannaccone, Riccardo Rinaldi and Rocco Antonio Montone

J. Clin. Med. 2024, 13(15), 4569; https://doi.org/10.3390/jcm13154569 - 5 Aug 2024

Cited by 3 | Viewed by 2900

Abstract

Nowadays, current guidelines on acute coronary syndrome (ACS) provide recommendations mainly based on the clinical presentation. However, greater attention is being directed to the specific pathophysiology underlying ACS, considering that plaque destabilization and rupture leading to luminal thrombotic obstruction is not the only [...] Read more.

Nowadays, current guidelines on acute coronary syndrome (ACS) provide recommendations mainly based on the clinical presentation. However, greater attention is being directed to the specific pathophysiology underlying ACS, considering that plaque destabilization and rupture leading to luminal thrombotic obstruction is not the only pathway involved, albeit the most recognized. In this review, we discuss how intracoronary imaging and biomarkers allow the identification of specific ACS endotypes, leading to the recognition of different prognostic implications, tailored management strategies, and new potential therapeutic targets. Furthermore, different strategies can be applied on a personalized basis regarding antithrombotic therapy, non-culprit lesion revascularization, and microvascular obstruction (MVO). With respect to myocardial infarction with non-obstructive coronary arteries (MINOCA), we will present a precision medicine approach, suggested by current guidelines as the mainstay of the diagnostic process and with relevant therapeutic implications. Moreover, we aim at illustrating the clinical implications of targeted strategies for ACS secondary prevention, which may lower residual risk in selected patients. Full article

(This article belongs to the Special Issue Acute Coronary Syndrome: Current State of Diagnosis and Treatment)

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26 pages, 2122 KiB

Open AccessReview

Management of Acute Coronary Syndromes in Older People: Comprehensive Review and Multidisciplinary Practice-Based Recommendations

by Ahthavan Narendren, Natalie Whitehead, Louise M. Burrell, Matias B. Yudi, Julian Yeoh, Nicholas Jones, Laurence Weinberg, Lachlan F. Miles, Han S. Lim, David J. Clark, Ali Al-Fiadh, Omar Farouque and Anoop N. Koshy

J. Clin. Med. 2024, 13(15), 4416; https://doi.org/10.3390/jcm13154416 - 28 Jul 2024

Cited by 1 | Viewed by 4806

Abstract

Managing health care for older adults aged 75 years and older can pose unique challenges stemming from age-related physiological differences and comorbidities, along with elevated risk of delirium, frailty, disability, and polypharmacy. This review is aimed at providing a comprehensive analysis of the [...] Read more.

Managing health care for older adults aged 75 years and older can pose unique challenges stemming from age-related physiological differences and comorbidities, along with elevated risk of delirium, frailty, disability, and polypharmacy. This review is aimed at providing a comprehensive analysis of the management of acute coronary syndromes (ACS) in older patients, a demographic substantially underrepresented in major clinical trials. Because older patients often exhibit atypical ACS symptoms, a nuanced diagnostic and risk stratification approach is necessary. We aim to address diagnostic challenges for older populations and highlight the diminished sensitivity of traditional symptoms with age, and the importance of biomarkers and imaging techniques tailored for older patients. Additionally, we review the efficacy and safety of pharmacological agents for ACS management in older people, emphasizing the need for a personalized and shared decision-making approach to treatment. This review also explores revascularization strategies, considering the implications of invasive procedures in older people, and weighing the potential benefits against the heightened procedural risks, particularly with surgical revascularization techniques. We explore the perioperative management of older patients experiencing myocardial infarction in the setting of noncardiac surgeries, including preoperative risk stratification and postoperative care considerations. Furthermore, we highlight the critical role of a multidisciplinary approach involving cardiologists, geriatricians, general and internal medicine physicians, primary care physicians, and allied health, to ensure a holistic care pathway in this patient cohort. Full article

(This article belongs to the Special Issue Acute Coronary Syndrome: Current State of Diagnosis and Treatment)

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13 pages, 891 KiB

Open AccessReview

Revascularization Strategy in Myocardial Infarction with Multivessel Disease

by Alexander Jobs, Steffen Desch, Anne Freund, Hans-Josef Feistritzer and Holger Thiele

J. Clin. Med. 2024, 13(7), 1918; https://doi.org/10.3390/jcm13071918 - 26 Mar 2024

Cited by 5 | Viewed by 2957

Abstract

The proportion of patients with multivessel coronary artery disease in individuals experiencing acute coronary syndrome (ACS) varies based on age and ACS subtype. In patients with ST-segment elevation myocardial infarction (STEMI) without cardiogenic shock, the prognostic benefit of complete revascularization has been demonstrated [...] Read more.

The proportion of patients with multivessel coronary artery disease in individuals experiencing acute coronary syndrome (ACS) varies based on age and ACS subtype. In patients with ST-segment elevation myocardial infarction (STEMI) without cardiogenic shock, the prognostic benefit of complete revascularization has been demonstrated by several randomized trials and meta-analyses, leading to a strong guideline recommendation. However, similar data are lacking for ACS without ST-segment elevation (NSTE-ACS). Non-randomized data suggesting a benefit from complete revascularization in non-ST-segment elevation myocardial infarction (NSTEMI) are prone to selection bias and should be interpreted with caution. A series of large randomized controlled trials have been initiated recently to address these open questions. Full article

(This article belongs to the Special Issue Acute Coronary Syndrome: Current State of Diagnosis and Treatment)

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Other

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17 pages, 3553 KiB

Open AccessSystematic Review

Cardiovascular Outcomes after Paclitaxel-Coated Balloon Angioplasty versus Drug-Eluting Stent Placement for Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

by Yuki Kondo, Tetsuya Ishikawa, Masatoshi Shimura, Kota Yamada, Tomoaki Ukaji, Yohei Tamura, Miona Arai, Kahoko Mori, Taro Takeyama, Yuichi Hori, Itaru Hisauchi, Shiro Nakahara, Yuji Itabashi, Sayuki Kobayashi and Isao Taguchi

J. Clin. Med. 2024, 13(5), 1481; https://doi.org/10.3390/jcm13051481 - 4 Mar 2024

Cited by 3 | Viewed by 2371

Abstract

Background: We conducted a systematic review and meta-analysis to examine the feasibility of paclitaxel-coated balloon (PCB) angioplasty for de novo lesions in patients with acute coronary syndrome (ACS) by comparing with drug-eluting stent (DES) placement. Methods: By a systematic literature search, [...] Read more.

Background: We conducted a systematic review and meta-analysis to examine the feasibility of paclitaxel-coated balloon (PCB) angioplasty for de novo lesions in patients with acute coronary syndrome (ACS) by comparing with drug-eluting stent (DES) placement. Methods: By a systematic literature search, nine (five randomized controlled, two retrospective propensity-score matched, and two retrospective baseline-balanced) studies comparing the midterm clinical and angiographic outcomes after PCB angioplasty and DES placement were included, yielding 974 and 1130 ACS cases in PCB and DES groups, respectively. Major adverse cardiac event (MACE) was defined as a composite of cardiac mortality (CM), all-cause mortality (ACM), myocardial infarction (MI), target vessel revascularization (TVR), and target lesion revascularization (TLR). Late luminal loss (LLL) and bleeding events (BLD) were also estimated. Results: The frequencies of MACE in PCB and DES groups were 8.42% and 10.62%, respectively. PCB angioplasty had no significant impacts on all of MACE (risk ratio: 0.90, 95%CI: 0.68–1.18, p = 0.44), CM, ACM, MI, TVR, TLR, BLD, and LLL, compared to DES placement in random-effects model. Conclusions: The present systematic review and meta-analysis showed the feasibility of PCB angioplasty for the de novo lesions in patients with ACS in comparison with DES placement by the emergent procedures. Full article

(This article belongs to the Special Issue Acute Coronary Syndrome: Current State of Diagnosis and Treatment)

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11 pages, 1257 KiB

Open AccessSystematic Review

The Prognostic Role of Platelet-to-Lymphocyte Ratio in Acute Coronary Syndromes: A Systematic Review and Meta-Analysis

by Michal Pruc, Frank William Peacock, Zubaid Rafique, Damian Swieczkowski, Krzysztof Kurek, Monika Tomaszewska, Burak Katipoglu, Maciej Koselak, Basar Cander and Lukasz Szarpak

J. Clin. Med. 2023, 12(21), 6903; https://doi.org/10.3390/jcm12216903 - 2 Nov 2023

Cited by 10 | Viewed by 1873

Abstract

This study aimed to investigate the potential prognostic role of the platelet-to-lymphocyte (PLR) ratio in patients presenting with suspected acute coronary syndromes (ACS). A systematic search of PubMed Central, Scopus, EMBASE, and the Cochrane Library from conception through 20 August 2023 was conducted. [...] Read more.

This study aimed to investigate the potential prognostic role of the platelet-to-lymphocyte (PLR) ratio in patients presenting with suspected acute coronary syndromes (ACS). A systematic search of PubMed Central, Scopus, EMBASE, and the Cochrane Library from conception through 20 August 2023 was conducted. We used odds ratios (OR) as the effect measure with 95% confidence intervals (CIs) for dichotomous data and mean differences (MD) with a 95% CI for continuous data. If I2 was less than 50% or the p value of the Q tests was less than 0.05, a random synthesis analysis was conducted. Otherwise, a fixed pooled meta-analysis was performed. Nineteen studies fulfilled the eligibility criteria and were included in the meta-analysis. PLR was higher in MACE-positive (164.0 ± 68.6) than MACE-negative patients (115.3 ± 36.9; MD = 40.14; 95% CI: 22.76 to 57.52; p < 0.001). Pooled analysis showed that PLR was higher in AMI patients who died (183.3 ± 30.3), compared to survivors (126.2 ± 16.8; MD = 39.07; 95% CI: 13.30 to 64.84; p = 0.003). It was also higher in the ACS vs. control group (168.2 ± 81.1 vs. 131.9 ± 37.7; MD = 39.01; 95% CI: 2.81 to 75.21; p = 0.03), STEMI vs. NSTEMI cohort (165.5 ± 92.7 vs. 159.5 ± 87.8; MD = 5.98; 95% CI: −15.09 to 27.04; p = 0.58), and MI vs. UAP populations (162.4 ± 90.0 vs. 128.2 ± 64.9; MD = 18.28; 95% CI: −8.16 to 44.71; p = 0.18). Overall, our findings confirmed the potential prognostic role of the plate-let-to-lymphocyte (PLR) ratio in patients presenting with suspected acute coronary syndromes (ACS). Its use as a risk stratification tool should be examined prospectively to define its capability for evaluation in cardiovascular patients. Full article

(This article belongs to the Special Issue Acute Coronary Syndrome: Current State of Diagnosis and Treatment)

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