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Coronary Artery Disease (CAD): Diagnosis, Treatment, Management and Prognosis

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

Deadline for manuscript submissions: closed (15 April 2022) | Viewed by 11992

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Dr. Tadeusz Osadnik

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Guest Editor

1. Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice Ul. Jordana 38, 41-800 Zabrze, Poland
2. Department of Cardiology and Angiology, Silesian Centre for Heart Diseases Ul. Marii Curie Skłodowskiej 9 41-800 Zabrze, Poland
Interests: cardiovascular medicine; genetics; pharmacotherapy; coronary artery disease; prognosis

Special Issue Information

Dear Colleagues,

Journal of Clinical Medicine (ISSN 2077-0383, IF -3.303), an Open Access journal, is publishing a Special Issue entitled “Coronary Artery Disease (CAD): Diagnosis, Treatment, Management and Prognosis” and has approached me to serve as Guest Editor. In this regard, I would be very pleased if you would agree to contribute to this Special Issue.

The diagnosis of CAD, both non-invasive and invasive, currently goes far beyond the performance of treadmill test, stress echocardiography and coronary angiography. More accurate non-invasive diagnostic methods, such as multi-slice computed tomography, myocardial perfusion scintigraphy by single photon emission tomography (SPECT) or positron emission tomography (PET), cardiac stress magnetic resonance (MRI) are more and more widely used, enabling the accurate assessment of the severity of CAD and myocardial viability. In the invasive diagnosis of CAD, fractional flow reserve (FFR) is now the standard in the assessment of borderline lesions. In the assessment of coronary stent placement using the intravascular ultrasound (IVUS) method or optical coherence tomography (OCT), which invasive cardiologists have more and more opportunities to use, positively influences the effectiveness of percutaneous coronary intervention (PCI).

Reduced time of dual antiplatelet therapy (DAPT) after stent implantation in chronic coronary syndromes, choice of antiplatelet drug based on CYP2C19 polymorphism, addition of low dose of novel oral anticoagulant drug (NOAC) to DAPT are recent advancements in the management of CAD. Lower target levels of LDL-C in the group of high-risk patients, the introduction of PCSK-9 inhibitors to therapy are significant changes in the primary and secondary prevention of CAD.

New predictive models based on the integration of data from -omics and clinical sciences represent the future of predicting adverse cardiovascular events in the group of patients with coronary artery disease.

Feel free to submit your work in the form of an original research paper, a short communication, or a focused review regarding diagnosis, treatment, prognosis and management of CAD.

Best regards

Dr. Tadeusz Osadnik
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.

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Keywords

Cardiovascular medicine
Genetics
Pharmacotherapy
Coronary Artery Disease
Prognosis

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Published Papers (4 papers)

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Research

9 pages, 455 KiB

Open AccessArticle

Procalcitonin Predicts Bacterial Infection, but Not Long-Term Occurrence of Adverse Events in Patients with Acute Coronary Syndrome

by Rita Pavasini, Gioele Fabbri, Federico Marchini, Nicola Bianchi, Maria Angela Deserio, Federico Sanguettoli, Filippo Maria Verardi, Daniela Segala, Graziella Pompei, Elisabetta Tonet, Matteo Serenelli, Serena Caglioni, Gabriele Guardigli, Gianluca Campo and Rosario Cultrera

J. Clin. Med. 2022, 11(3), 554; https://doi.org/10.3390/jcm11030554 - 22 Jan 2022

Cited by 7 | Viewed by 3288

Abstract

This study compiles data to determine if procalcitonin (PCT) values may predict both the risk of bacterial infection and potentially negative long-term outcomes in patients with acute coronary syndromes (ACS). All patients with a diagnosis of ACS that had PCT levels assessed during the first 24 h of hospitalization were enrolled in this study. The primary outcome was to detect the presence of bacterial infection defined as the occurrence of fever and at least one positive blood or urinary culture with clinical signs of infection. The secondary outcome was to monitor the occurrence after 1 year of the composite outcome of all-cause mortality, stroke and myocardial infarction. Overall, 569 patients were enrolled (mean age 69.37 ± 14 years, 30% females). Of these, 44 (8%) met the criteria for bacterial infection. After multivariate analysis, PCT and SBP were found to be independent predictors of bacterial infections (OR for PCT above the cut-off 2.67, 95% CI 1.09–6.53, p = 0.032 and OR for SBP 0.98, 95% CI 0.97–0.99, p = 0.043). After 1 year, the composite outcome of all-cause death, MI and stroke occurred in 104 patients (18%). PCT was not found to be an independent predictor of these outcomes. In conclusion, when assessing ACS, we found that testing for PCT levels during hospital admissions procedures was a good predictor of bacterial infections but not of all-cause mortality, stroke, or myocardial infarction. Clinicaltrial.org identifier: NCT02438085. Full article

(This article belongs to the Special Issue Coronary Artery Disease (CAD): Diagnosis, Treatment, Management and Prognosis)

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10 pages, 1023 KiB

Open AccessArticle

Angiographic Characteristics and Outcomes of Percutaneous Coronary Intervention of Reattempted Chronic Total Occlusion: Potential Contributing Factors to Procedural Success

by Mohsen Mohandes, Cristina Moreno, Mónica Fuertes, Sergio Rojas, Alberto Pernigotti, Diego Zambrano, Marta Guillén, Jordi Guarinos and Alfredo Bardají

J. Clin. Med. 2021, 10(23), 5661; https://doi.org/10.3390/jcm10235661 - 30 Nov 2021

Cited by 2 | Viewed by 2171

Abstract

This study aimed to analyze angiographic characteristics of new attempted percutaneous coronary intervention (PCI) on chronic total occlusion (CTO) compared to first attempt group. The cohort of 527 CTO-PCIs was divided into first-attempt and re-attempt groups, and angiographic characteristics, level of complexity, and contributing factors to failure were analyzed. Between-group success rate difference and potential angiographic and technical aspects contributing to the success in new attempts were scrutinized. A total of 47 new PCIs in 39 patients were performed. The reattempt group showed higher J-CTO score compared to the first-attempt group (2.4 ± 1.06 vs. 1.2 ± 1.06; p < 0.001). The use of more complex techniques and devices such as retrograde approach (29.8% vs. 12.9%) and IVUS (48.9 vs. 27.3%; p: 0.002) were more frequent in the reattempt group. Both procedural and fluoroscopy time were higher in the reattempt group (197 ± 83.9 vs. 150.1 ± 72.3 and 97.7 ± 55.4 vs. 68.7 ± 43, respectively; p < 0.001). There was no between-group difference in terms of technical success (79.8 vs. 76.6% for first attempt vs. reattempt group, respectively; p: 0.6). The overall success rate increased by 6.1%, achieving 85.9% in the entire cohort. Reattempted CTO-PCIs required more complex techniques and had comparable technical success rate with regard to the first-attempt group. Full article

(This article belongs to the Special Issue Coronary Artery Disease (CAD): Diagnosis, Treatment, Management and Prognosis)

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8 pages, 904 KiB

Open AccessArticle

Association of Echocardiographic Diastolic Dysfunction with Discordance of Invasive Intracoronary Pressure Indices

by Hassan Tahir, James Livesay, Benjamin Fogelson and Raj Baljepally

J. Clin. Med. 2021, 10(16), 3670; https://doi.org/10.3390/jcm10163670 - 19 Aug 2021

Cited by 2 | Viewed by 1980

Abstract

Instantaneous wave-free ratio (iFR)-guided coronary revascularization has similar clinical outcomes compared to fractional flow reserve (FFR)-guided revascularization strategy. However, some studies have shown a discordance of around 20% between iFR and FFR. Although various factors have been reported in the literature to affect pressure indices and lead to such discordance, there is a paucity of data regarding the effect of diastolic dysfunction on functional assessment of coronary arteries. Our study aimed to investigate whether there was an association between echocardiographic left ventricular diastolic dysfunction and iFR/FFR discordance. This retrospective observational study evaluated 100 patients with angiographically intermediate coronary stenosis (50–70%) who underwent physiological testing with iFR and FFR. Transthoracic echocardiograms were reviewed to assess echocardiographic indices of diastolic function. The study population was divided into two groups based on diastolic function. iFR and FFR discordance was measured in each group and compared to evaluate the statistical difference. The mean age of the study population was 66.22 ± 10.02 years. Discordance between iFR and FFR was seen in 45.16% of patients with diastolic dysfunction compared to 24.64% of patients with normal diastolic function (p = 0.04). Multivariable logistic regression analysis indicated that echocardiographic E/e′ was independently associated with iFR/FFR discordance (p = 0.02). Left ventricular diastolic dysfunction is a significant factor that can lead to discordance between iFR and FFR and should be taken into account during coronary physiological testing. Full article

(This article belongs to the Special Issue Coronary Artery Disease (CAD): Diagnosis, Treatment, Management and Prognosis)

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14 pages, 1107 KiB

Open AccessArticle

A Risk Score for Predicting Long-Term Mortality Following Off-Pump Coronary Artery Bypass Grafting

by Tomasz Kamil Urbanowicz, Michał Michalak, Aleksandra Gąsecka, Anna Olasińska-Wiśniewska, Bartłomiej Perek, Michał Rodzki, Michał Bociański and Marek Jemielity

J. Clin. Med. 2021, 10(14), 3032; https://doi.org/10.3390/jcm10143032 - 7 Jul 2021

Cited by 26 | Viewed by 3541

Abstract

Background: Off-pump coronary artery bypass grafting (OPCAB) comprises 15–30% of all bypass grafting surgeries. The currently available perioperative scores such as Euroscore and STS score do not specifically predict long-term mortality after off-pump procedures. The neutrophil-to-lymphocyte ratio (NLR) is one of the new, easily accessible markers of inflammation with proven predictive value in cardiovascular diseases. We aimed to develop the first risk score for long-term mortality after OPCAB and to determine if the perioperative value of NLR predicts long-term mortality in OPCAB patients. Methods: In total, 440 consecutive patients with multivessel stable coronary artery disease undergoing OPCAB were recruited. Differential leukocyte counts were obtained by a routine hematology analyzer. Data regarding mortality during a median follow-up time of 5.3 years were obtained from the Polish National Health Service database. An independent population of 242 patients served as a validation cohort. Results: All-cause mortality was influenced by different clinical risk factors. In multivariate regression analysis, chronic obstructive pulmonary disease, stroke history, post-operative NLR and LVEF were independent predictors of mortality. Combing all independent predictors predicted long-term all-cause mortality with 68.5% sensitivity and 71.5% specificity (AUC = 0.704, p < 0.001). After weighing these variables according to their estimates in a multivariate regression model, we developed a score to predict mortality in patients undergoing OPCAB (PREDICT-OPCAB Score, ranging from 0 to 10). Patients with a high score were at higher risk of mortality within the median 5.3 years of follow-up (score 0–3: 8.3%; 4–6: 27.0%; 7–10: 40.0%; p < 0.001 for score 0–3 vs. 4–6 and 7–10). This association was confirmed in the validation cohort. Conclusions: We developed and validated the first simplified risk score to predict mortality following OPCAB based on easily accessible clinical factors. This risk score can be used when obtaining a patient’s informed consent and as an aid in determining treatment. Full article

(This article belongs to the Special Issue Coronary Artery Disease (CAD): Diagnosis, Treatment, Management and Prognosis)

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