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Clinical Advances in Myocardial Infarction
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Clinical Advances in Myocardial Infarction

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

Deadline for manuscript submissions: closed (10 October 2024) | Viewed by 25771

Special Issue Editors

Dr. Luca Donazzan

E-Mail Website
Guest Editor
Department of Cardiology, San Maurizio Hospital, Bolzano, Italy
Interests: acute coronary syndromes; percutaneous coronary intervention; myocardial revascularization; coronary physiology; elderly population
Dr. Simone Biscaglia

E-Mail Website
Guest Editor
Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
Interests: acute coronary syndromes; percutaneous coronary intervention; intracoronary physiology; elderly population
Dr. Giulia Masiero

E-Mail Website
Guest Editor
Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
Interests: acute coronary syndromes; percutaneous coronary intervention; bioresorbable vascular scaffold; transcatheter heart therapies; transcatheter aortic valve implantation; transcatheter mitral valve repair; transcatheter tricuspid valve repair

Special Issue Information

Dear Colleagues,

The prognostic relevance of the rapid and effective treatment of myocardial infarction (MI) is well established. Since the development of primary percutaneous intervention (pPCI), the mortality and morbidity of MI has dramatically reduced. Both procedural aspects of pPCI as well as periprocedural pharmacotherapy has contributed to further improvements in care. Nowadays, the use of an invasive approach is also aimed at frail and elderly patients with multiple comorbidities (e.g., anaemia, chronic kidney disease, diabetes mellitus) affected by acute coronary syndromes (ACSs). Technological advances have also enabled the acute treatment of calcified lesions, complex bifurcations, and multivessel coronary artery disease. Moreover, the use of intracoronary imaging, physiology, and left ventricular assistance has improved the safety and efficacy of PCI procedures.

Notwithstanding, many issues in the treatment of ACS deserve further investigation, from risk prediction modelling, medical treatment strategies, timing of angiography, and revascularization strategies (especially in the evolving scenario of acute MI with no obstructive coronary arteries (MINOCA)) to long-term management.

This Special Issue focuses on the cutting-edge treatment strategies, devices, and tools used for acute coronary syndromes; we invite the submission of original clinical studies, reviews, and state-of-the-art manuscripts which revolve around this topic.

Dr. Luca Donazzan
Dr. Simone Biscaglia
Dr. Giulia Masiero
Guest Editors

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

  • acute myocardial infarction
  • elderly
  • percutaneous coronary intervention
  • complex coronary lesions
  • intravascular imaging
  • multivessel disease
  • coronary physiology
  • dual antiplatelet therapy

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Published Papers (4 papers)

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Research

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11 pages, 522 KiB  
Article
Predictors and Impact of Cardiogenic Shock in Oldest-Old ST-Elevation Myocardial Infarction Patients
by Luca Donazzan, Alessandro Ruzzarin, Simone Muraglia, Enrico Fabris, Monica Verdoia, Filippo Zilio, Giorgio Caretta, Andrea Pezzato, Gianluca Campo and Matthias Unterhuber
J. Clin. Med. 2025, 14(2), 504; https://doi.org/10.3390/jcm14020504 - 14 Jan 2025
Viewed by 804
Abstract
Background: Cardiogenic shock (CS) is the most frequent cause of in-hospital mortality after ST-elevation myocardial infarction (STEMI). Data about CS in very elderly (age ≥ 85 years) STEMI patients are scarce. We sought to assess the prognostic factors and the short- and [...] Read more.
Background: Cardiogenic shock (CS) is the most frequent cause of in-hospital mortality after ST-elevation myocardial infarction (STEMI). Data about CS in very elderly (age ≥ 85 years) STEMI patients are scarce. We sought to assess the prognostic factors and the short- and mid-term impact of CS in this population. Methods: Consecutive very elderly STEMI patients undergoing invasive treatment were included in a retrospective multicenter registry. Results: Among 608 patients, 72 (11.8%) fulfilled experienced CS. Peripheral artery disease (PAD) (OR: 2.25, 95% CI: 1.29–3.92, p < 0.01) and cardiac arrest at presentation (OR: 4.36, 95% CI: 2.32–8.21, p < 0.01) were the major independent predictors of CS. Age (HR: 1.07, 95% CI: 1.03–1.11, p < 0.001), PAD (HR: 1.29, 95% CI: 1.01–1.66, p = 0.045), previous MI (HR: 2.16, 95% CI: 1.32–3.55, p = 0.002), and cardiac arrest at presentation (HR: 1.59, 95% CI: 1.29–1.96, p < 0.001) were the major independent predictors of death. CS was associated with a higher risk of mortality at 30 days (adjusted HR: 4.21, 95% CI: 2.19 to 7.78, p < 0.01) mostly driven by higher intraprocedural and in-hospital mortality. Among patients who survived the acute phase and hospitalization, CS at presentation was not associated with a higher mortality risk during the remaining follow-up period (log-rank p = 0.78). Conclusions: At short-term follow-up, very elderly STEMI patients presenting with CS had a higher risk of mortality when compared to non-CS patients. Interestingly, CS patients surviving the acute phase showed a similar survival rate to non-CS patients after discharge. Full article
(This article belongs to the Special Issue Clinical Advances in Myocardial Infarction)
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11 pages, 883 KiB  
Article
Evaluation of Inflammatory Markers in Predicting Coronary Complexity: Insights from the SYNTAX II Score in NSTEMI Patients
by Murat Bilgin, Emre Akkaya and Recep Dokuyucu
J. Clin. Med. 2024, 13(19), 5940; https://doi.org/10.3390/jcm13195940 - 6 Oct 2024
Cited by 1 | Viewed by 1202
Abstract
Objectives: Non-ST-elevation myocardial infarction (NSTEMI) is characterized by the absence of pathological ST segment elevation but an increase in biological markers. The SYNTAX II score (SS-II) is calculated to evaluate the complexity of coronary artery disease and to guide treatment decisions between [...] Read more.
Objectives: Non-ST-elevation myocardial infarction (NSTEMI) is characterized by the absence of pathological ST segment elevation but an increase in biological markers. The SYNTAX II score (SS-II) is calculated to evaluate the complexity of coronary artery disease and to guide treatment decisions between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). The aim of this study is to evaluate the relationship of socio-demographic data and biochemical markers with SS-II in NSTEMI patients. Materials and Methods: Six hundred patients who were admitted to the private Aktif International Hospital cardiology clinic between January 2020 and January 2024 and were diagnosed with NSTEMI were included in the study. Severity, extent, and clinical evaluation of atherosclerosis were determined using risk factors, laboratory tests, and coronary angiography. Patients were divided into two groups according to their SS-II score: low (≤ 22) and high SS-II (> 32). Socio-demographic data, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and monocyte-to-HDL-C ratio (MHR) were compared between the two groups. Results: Group 1 (SS-II ≤ 22) included 380 patients, and group 2 (SS-II > 32) included 220 patients. There was a statistically significant difference in HDL, creatine value, white blood cell, troponin I, hs-TnT, and monocyte values in group 2 compared with group 1 (p = 0.001, p = 0.018, p = 0.031, and p = 0.001, respectively). NLR, MLR, MHR, and SS values were statistically significantly higher in group 2 compared with group 1 (p = 0.015, p = 0.002, p = 0.001, and p = 0.001, respectively). The risk factors were found to be significantly associated with high-risk NSTEMI (SS-II > 32) in a logistic regression analysis and included peripheral artery disease (PAD) (OR: 3.028, p = 0.040), troponin I (OR: 3.575, p = 0.015), hs-TnT (OR: 4.221, p = 0.010), NLR (OR: 1.528, p = 0.024). MLR (OR: 5.248, p = 0.012), and MHR (OR: 7.122, p = 0.010). ROC analysis revealed that NLR (AUC: 0.691, p = 0.016), MLR (AUC: 0.731, p = 0.004), and MHR (AUC: 0.824, p = 0.003) had higher predictive power than other parameters in patients with high-risk NSTEMI (SS-II > 32). Conclusions: We found that NLR, MLR, and MHR levels are associated with the severity of coronary artery disease. We think that adding these easily and quickly measurable parameters to routine laboratory results may support the clinician in evaluating the complexity of coronary artery disease and guiding treatment decisions in NSTEMI patients. Full article
(This article belongs to the Special Issue Clinical Advances in Myocardial Infarction)
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Review

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17 pages, 1876 KiB  
Review
Antiplatelet Therapy and Anticoagulation before, during, and after Acute Coronary Syndrome
by Christoph C. Kaufmann, Marie Muthspiel, Laura Lunzer, Edita Pogran, David Zweiker, Achim Leo Burger, Johann Wojta and Kurt Huber
J. Clin. Med. 2024, 13(8), 2313; https://doi.org/10.3390/jcm13082313 - 17 Apr 2024
Cited by 5 | Viewed by 12311
Abstract
Acute coronary syndrome (ACS) remains a major challenge in clinical practice, requiring rapid and effective antithrombotic treatment to mitigate adverse ischemic events while minimizing the risk of bleeding. In recent years, results from several clinical trials addressing this issue through various approaches have [...] Read more.
Acute coronary syndrome (ACS) remains a major challenge in clinical practice, requiring rapid and effective antithrombotic treatment to mitigate adverse ischemic events while minimizing the risk of bleeding. In recent years, results from several clinical trials addressing this issue through various approaches have substantially improved the treatment landscape for patients presenting with ACS. The emergence of new, potent P2Y12 inhibitors has significantly enhanced thrombotic risk reduction and different strategies for de-escalating and shortening dual antiplatelet therapy (DAPT) have demonstrated promising outcomes in reducing bleeding rates. Furthermore, data from ongoing trials focusing on novel therapeutic agents and investigating alternative treatment strategies to optimize outcomes for ACS patients are expected in the next few years. In this review, we summarize the current knowledge and emphasize the critical role of individualized treatment approaches tailored to patient-specific risk factors and individual clinical scenarios. Full article
(This article belongs to the Special Issue Clinical Advances in Myocardial Infarction)
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16 pages, 1005 KiB  
Review
Lipid-Lowering Therapy after Acute Coronary Syndrome
by Edita Pogran, Achim Leo Burger, David Zweiker, Christoph Clemens Kaufmann, Marie Muthspiel, Gersina Rega-Kaun, Alfa Wenkstetten-Holub, Johann Wojta, Heinz Drexel and Kurt Huber
J. Clin. Med. 2024, 13(7), 2043; https://doi.org/10.3390/jcm13072043 - 1 Apr 2024
Cited by 5 | Viewed by 10768
Abstract
Achieving guideline-recommended low-density lipoprotein cholesterol (LDL-C) targets remains a significant challenge in clinical practice. This review assesses the barriers to reaching LDL-C goals and explores the potential solutions to these issues. When aiming for the recommended LDL-C goal, strategies like “lower is better” [...] Read more.
Achieving guideline-recommended low-density lipoprotein cholesterol (LDL-C) targets remains a significant challenge in clinical practice. This review assesses the barriers to reaching LDL-C goals and explores the potential solutions to these issues. When aiming for the recommended LDL-C goal, strategies like “lower is better” and “strike early and strong” should be used. The evidence supports the safety and efficacy of intensive lipid-lowering therapy post-acute coronary syndrome (ACS), leading to improved long-term cardiovascular health and atherosclerotic plaque stabilization. Despite the availability of effective lipid-lowering therapies, such as high-intensity statins, ezetimibe, the combination of both, bempedoic acid, and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, a substantial proportion of patients do not meet their LDL-C targets. Contributing factors include systemic healthcare barriers, healthcare provider inertia, patient non-adherence, and statin intolerance. Statin intolerance, often rather statin reluctance, is a notable obstacle due to perceived or expected side effects, which can lead to discontinuation of therapy. In conclusion, while there are obstacles to achieving optimal LDL-C levels post-ACS, these can be overcome with a combination of patient-centric approaches, clinical vigilance, and the judicious use of available therapies. The safety and necessity of reaching lower LDL-C goals to improve outcomes in patients post-ACS are well-supported by current evidence. Full article
(This article belongs to the Special Issue Clinical Advances in Myocardial Infarction)
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