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Targeted Diagnosis and Treatment of Coronary Artery Disease: 2nd Edition
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Targeted Diagnosis and Treatment of Coronary Artery Disease: 2nd Edition

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

Deadline for manuscript submissions: closed (15 March 2026) | Viewed by 10586

Special Issue Editor

Dr. Antonio Nenna

E-Mail Website
Guest Editor
Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
Interests: cardiac surgery; myocardial revascularization; angiogenesis
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

It is my pleasure to invite you to contribute to this Special Issue, “Targeted Diagnosis and Treatment of Coronary Artery Disease: 2nd Edition”. This is a new volume proceeding the eight papers we published in the first volume (for more details, please visit: https://www.mdpi.com/journal/jcm/special_issues/NSS7142D33).

Coronary artery disease remains a leading cause of morbidity and mortality worldwide. Efforts in preclinical and clinical research aim to improve life expectancy and quality of life while reducing healthcare-associated costs. Rigorous out-patient selection, the availability of safe and effective percutaneous devices and surgical techniques, and a careful research approach are crucial to ensuring that these developments meet patients’ clinical needs. This Special Issue aims to provide an overview of the latest discoveries and new findings, analyses of previously published data, and new opinions and perspectives on the targeted diagnosis and treatment in coronary artery disease. Original research articles and reviews are welcome. Research areas of interest include (but are not limited to) the following: myocardial circulation and pathophysiologic changes during ischemia and after revascularization; percutaneous coronary intervention, with an emphasis on emerging techniques and technologies; coronary artery bypass graft, with an emphasis on functional-based revascularization or total arterial revascularization; intravascular ultrasound (IVUS); fractional flow reserve (FFR); instantaneous wave-free ratio (iFR); and angiogenesis following percutaneous or surgical revascularization.

Dr. Antonio Nenna
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. 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
  • myocardial revascularization
  • percutaneous coronary intervention
  • cardiac surgery
  • coronary artery bypass graft
  • intravascular ultrasound
  • fractional flow reserve
  • instantaneous wave-free ratio
  • angiogenesis

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Related Special Issue

Published Papers (5 papers)

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Research

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20 pages, 16316 KB  
Article
Percutaneous Coronary Intervention for Chronic Total Occlusions Modulates Cardiac Hypoxic and Inflammatory Stress
by Luis Carlos Maestre-Luque, Rafael Gonzalez-Manzanares, Ignacio Gallo, Francisco Hidalgo, Javier Suárez de Lezo, Miguel Romero, Simona Espejo-Perez, Carlos Perez-Sanchez, Julio Manuel Martínez-Moreno, Rafael González-Fernandez, Manuel Pan and Soledad Ojeda
J. Clin. Med. 2026, 15(2), 517; https://doi.org/10.3390/jcm15020517 - 8 Jan 2026
Viewed by 597
Abstract
Background/Objectives: The cardiac hypoxia- and inflammation-associated processes in patients with chronic coronary artery disease remain unknown. The coronary sinus (CS) can be used to explore changes in cardiac microenvironment. This study sought to evaluate acute changes in the CS concentration of hypoxia [...] Read more.
Background/Objectives: The cardiac hypoxia- and inflammation-associated processes in patients with chronic coronary artery disease remain unknown. The coronary sinus (CS) can be used to explore changes in cardiac microenvironment. This study sought to evaluate acute changes in the CS concentration of hypoxia and inflammation-associated biomarkers after the percutaneous revascularization of chronic total occlusions (CTO-PCI). Additionally, we explored changes in systemic inflammation and the potential of CS biomarkers to predict left ventricular ejection fraction (LVEF) improvement on follow-up. Methods: Thirty-three patients undergoing CTO-PCI were included. Samples from CS were collected before and after the revascularization. Twenty-six protein biomarkers associated with hypoxia and inflammation were measured using proximity extension assay technology. Systemic inflammation markers and LVEF on cardiac magnetic resonance imaging were assessed at baseline and 6-month follow-up. Results: CTO-PCI yielded a significant decrease in the concentration of CS pro-angiogenic biomarkers (angiopoietin-1, vascular endothelial growth factors). In addition, there was a significant increase in the anti-inflammatory biomarker interleukin-10 and a decrease in several pro-inflammatory biomarkers like interleukin-1β. The acute response in cardiac microenvironment was followed by a mid-term reduction in systemic inflammatory markers, particularly high-sensitivity C-reactive protein. Notably, interleukin-10 showed good performance to identify patients achieving LVEF improvement on follow-up in our cohort. Conclusions: Our results suggest that CTO-PCI might attenuate cardiac hypoxic and inflammatory stress. These exploratory findings warrant confirmation in larger, controlled studies. Full article
(This article belongs to the Special Issue Targeted Diagnosis and Treatment of Coronary Artery Disease: 2nd Edition)
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14 pages, 922 KB  
Article
Five-Year Mortality of Patients with Perioperative Myocardial Infarction After On-Pump Isolated or Combined Coronary Artery Bypass Graft Surgery: A Retrospective Propensity Score-Weighted Analysis
by Christophe Beyls, Pierre Huette, Paul Luang, Hélène Kowalik, Chloé Andriamifidy-Berti, Mathieu Guilbart, Mickael Bernasinski, Patricia Besserve, Gilles Touati, Thierry Caus, Hervé Dupont, Yazine Mahjoub and Osama Abou-Arab
J. Clin. Med. 2025, 14(22), 7970; https://doi.org/10.3390/jcm14227970 - 10 Nov 2025
Viewed by 1105
Abstract
Background: Coronary artery bypass grafting (CABG) is a widely used procedure to treat coronary artery disease, performed either alone or in conjunction with other cardiac procedures. Perioperative myocardial infarction (pMI) remains a major complication after on-pump CABG and negatively influences survival. Its reported [...] Read more.
Background: Coronary artery bypass grafting (CABG) is a widely used procedure to treat coronary artery disease, performed either alone or in conjunction with other cardiac procedures. Perioperative myocardial infarction (pMI) remains a major complication after on-pump CABG and negatively influences survival. Its reported incidence varies with the applied definition, and little is known about its prognostic effect in combined surgeries. Objective: The aim of this study was to investigate the impact of pMI on 5-year survival after isolated or combined on-pump CABG. Methods: We retrospectively reviewed adult patients undergoing urgent or elective CABG with cardiopulmonary bypass at Amiens University Hospital between 2013 and 2017. Diagnosis of pMI followed the Fourth Universal Definition of myocardial infarction. The primary outcome was all-cause death within 5 years. Logistic regression and Cox proportional hazards analyses were performed, and inverse probability weighting based on propensity scores was used to minimize confounding. Results: Out of 712 patients, 112 (16%) experienced pMI. Five-year mortality was 32% in the pMI subgroup compared with 11% in those without pMI (p < 0.001). Before adjustment, pMI was associated with higher long-term mortality (HR = 2.62, 95%CI [1.73–4.00], p < 0.001). This effect persisted after weighting (HR = 2.43, 95% CI [1.56–3.78], p = 0.041). A landmark analysis excluding the first 30 postoperative days showed no significant link with later mortality (HR = 1.13, 95%CI [0.54–2.34], p = 0.74). Independent predictors of pMI included active smoking (OR = 2.24, 95% CI [1.36–3.69], p = 0.001) and prolonged bypass duration (>180 min) (OR = 2.57, 95% CI [1.19–5.34], p = 0.015). Conclusions: When defined by the Fourth Universal Definition, pMI was independently related to increased 5-year mortality following CABG, explained mainly by deaths occurring early after surgery. Full article
(This article belongs to the Special Issue Targeted Diagnosis and Treatment of Coronary Artery Disease: 2nd Edition)
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Review

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24 pages, 1445 KB  
Review
Intracoronary Imaging for the Management of Vulnerable Plaques
by Francesco Maria Animati, Rocco Antonio Montone, Francesco Fracassi, Luigi Cappannoli, Andrea Caffè, Vincenzo Scarica and Francesco Burzotta
J. Clin. Med. 2026, 15(5), 1678; https://doi.org/10.3390/jcm15051678 - 24 Feb 2026
Viewed by 709
Abstract
Vulnerable coronary plaques are the primary substrate for acute coronary syndromes, representing a significant challenge in cardiovascular care. This review examines the pivotal role of intracoronary imaging, specifically intravascular ultrasound (IVUS) and optical coherence tomography (OCT), in the detection and management of these [...] Read more.
Vulnerable coronary plaques are the primary substrate for acute coronary syndromes, representing a significant challenge in cardiovascular care. This review examines the pivotal role of intracoronary imaging, specifically intravascular ultrasound (IVUS) and optical coherence tomography (OCT), in the detection and management of these high-risk lesions. We detail the technical principles of these modalities and their unique capabilities in characterizing plaque morphology, from identifying thin-cap fibroatheromas (TCFA) to differentiating mechanisms of plaque rupture and erosion. The article further synthesizes evidence on how imaging-guided strategies—ranging from intensive medical therapy to emerging interventional approaches like preventive stenting—can stabilize vulnerable plaques and improve patient outcomes. Finally, we explore future directions, including the integration of artificial intelligence and hybrid imaging technologies, which promise to refine risk stratification and personalize the treatment of coronary artery disease. Full article
(This article belongs to the Special Issue Targeted Diagnosis and Treatment of Coronary Artery Disease: 2nd Edition)
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17 pages, 874 KB  
Review
Coronary Microvascular Dysfunction: Bridging the Diagnosis–Treatment Divide in Women with INOCA—A Review
by Alaukika Agarwal, Ronak Patel and Omar K. Khalique
J. Clin. Med. 2025, 14(17), 6054; https://doi.org/10.3390/jcm14176054 - 27 Aug 2025
Viewed by 4246
Abstract
Coronary microvascular dysfunction (CMD) is increasingly being recognized as a significant contributor of ischemic heart disease, particularly affecting women with angina and non-obstructive coronary arteries. This contemporary review synthesizes recent landmark evidence (2022–2024) revealing a striking paradox in CMD management. While diagnostic capabilities [...] Read more.
Coronary microvascular dysfunction (CMD) is increasingly being recognized as a significant contributor of ischemic heart disease, particularly affecting women with angina and non-obstructive coronary arteries. This contemporary review synthesizes recent landmark evidence (2022–2024) revealing a striking paradox in CMD management. While diagnostic capabilities have advanced dramatically—with CMD now identified in 41% of patients with non-obstructive coronary disease—this diagnostic success has not translated into therapeutic benefits. Recent meta-analyses demonstrate that CMD doubles cardiovascular risk (HR 2.08–2.45), yet the first randomized trial of invasive endotyping (CorCTA) found that improved diagnosis failed to improve symptoms despite a 4-fold enhancement in diagnostic accuracy. This diagnosis–treatment gap represents one of the most pressing challenges in contemporary cardiovascular medicine, reflecting fundamental failures that demand urgent reconceptualization. We examine current evidence on its prevalence, diagnostic approaches, and prognostic implications, highlighting the urgent need for CMD-specific therapies to bridge the gap between diagnostic capability and clinical outcomes. Until CMD-specific therapies emerge from dedicated research programs, clinicians must optimize available treatments while advocating for the resources and research focus this condition deserves. Full article
(This article belongs to the Special Issue Targeted Diagnosis and Treatment of Coronary Artery Disease: 2nd Edition)
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10 pages, 875 KB  
Review
Hybrid Coronary Revascularisation: Indications, Techniques, and Outcomes
by Ibrahim T. Fazmin and Jason M. Ali
J. Clin. Med. 2025, 14(3), 880; https://doi.org/10.3390/jcm14030880 - 29 Jan 2025
Cited by 6 | Viewed by 3417
Abstract
Hybrid coronary revascularisation (HCR) integrates coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) to combine the benefits of minimally invasive surgery and advanced stent technology. Typically, HCR involves off-pump left internal mammary artery (LIMA) to left anterior descending artery (LAD) bypass [...] Read more.
Hybrid coronary revascularisation (HCR) integrates coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) to combine the benefits of minimally invasive surgery and advanced stent technology. Typically, HCR involves off-pump left internal mammary artery (LIMA) to left anterior descending artery (LAD) bypass via minimally invasive direct coronary artery bypass (MIDCAB), complemented by PCI to non-LAD vessels. This approach avoids a full sternotomy and cardiopulmonary bypass while preserving the advantages of surgical revascularisation. Patient selection for HCR should be guided by a multidisciplinary heart team, targeting those with severe LAD disease and suitable non-LAD lesions for PCI. This review outlines the surgical techniques, anticoagulation strategies, and procedural sequencing employed in HCR, along with real-world outcomes from observational studies and randomised trials. While current evidence supports the safety and feasibility of HCR in appropriately selected patients, further large-scale randomised trials are needed to clarify its role in comparison to standalone CABG or PCI. Full article
(This article belongs to the Special Issue Targeted Diagnosis and Treatment of Coronary Artery Disease: 2nd Edition)
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