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Recent Advances in the Diagnosis and Treatment of Myocardial Infarction
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Recent Advances in the Diagnosis and Treatment of 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 (15 December 2024) | Viewed by 11617

Special Issue Editor

Dr. David Del Val

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Guest Editor
Servicio de Cardiología, Hospital Universitario de la Princesa, IIS-IP, Universidad Autónoma de Madrid, Madrid, Spain
Interests: acute myocardial infarction; interventional cardiology; acute coronary syndrome; cardiac catheterization; valvular heart disease; transcatheter aortic valve implantation; heart failure

Special Issue Information

Dear Colleagues,

Acute myocardial infarction is a major global health concern. In the past decade, significant advancements in its diagnosis and treatment have revolutionized patient care and outcomes. Innovations in diagnostic techniques, such as high-sensitivity cardiac troponin and other biomarkers, have facilitated earlier and more accurate diagnosis, enabling prompt intervention. Furthermore, advanced imaging modalities such as MRI and CT are playing an increasingly vital role in this pathology, enabling the detailed assessment of cardiac structures, aiding in accurate diagnosis, and facilitating risk stratification. Rapid reperfusion remains crucial for improving outcomes. Novel pharmacological treatments, including potent and rapid-action antiplatelet therapies and cholesterol-lowering drugs, have further enhanced the treatment landscape. Additionally, the widespread adoption of a new generation of drug-eluting stents has also contributed to enhanced outcomes. More recently, the emergence of diverse and promising devices for mechanical circulatory support has offered additional resources for patients with a poorer prognosis, although evidence regarding their use remains limited. However, despite these advancements, acute myocardial infarction remains a leading cause of death, underscoring the need for further research and innovation in this exciting field. This Special Issue welcomes the submission of original research and systematic reviews that investigate myocardial infarction, with a particular emphasis on innovations in diagnosis and management approaches.

Dr. David Del Val
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

  • myocardial infarction
  • heart failure
  • coronary artery disease
  • acute coronary syndromes
  • diagnosis
  • cardiogenic shock

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Published Papers (5 papers)

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Research

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10 pages, 223 KiB  
Article
Developing a Computational Phenotype of the Fourth Universal Definition of Myocardial Infarction for Inpatients
by Elliot A. Martin, Bryan Har, Robin L. Walker, Danielle A. Southern, Hude Quan and Cathy A. Eastwood
J. Clin. Med. 2024, 13(24), 7773; https://doi.org/10.3390/jcm13247773 - 19 Dec 2024
Viewed by 647
Abstract
Background: The fourth universal definition of myocardial infarction (MI) introduced the differentiation of acute myocardial injury from MI. In this study, we developed a computational phenotype for distinct identification of acute myocardial injury and MI within electronic medical records (EMRs). Methods: [...] Read more.
Background: The fourth universal definition of myocardial infarction (MI) introduced the differentiation of acute myocardial injury from MI. In this study, we developed a computational phenotype for distinct identification of acute myocardial injury and MI within electronic medical records (EMRs). Methods: Two cohorts were used from a Calgary-wide EMR system: a chart review of 3042 randomly selected inpatients from Dec 2014 to Jun 2015; and 11,685 episodes of care that included cardiac catheterization from Jan 2013 to Apr 2017. Electrocardiogram (ECG) reports were processed using natural language processing and combined with high-sensitivity troponin lab results to classify patients as having an acute myocardial injury, MI, or neither. Results: For patients with an MI diagnosis, only 64.0% (65.7%) in the catheterized cohorts (chart review cohort) had two troponin measurements within 6 h of each other. For patients with two troponin measurements within 6 h; of those with an MI diagnosis, our phenotype classified 25.2% (31.3%) with an acute myocardial injury and 62.2% (55.2%) with an MI in the catheterized cohort (chart review cohort); and of those without an MI diagnosis, our phenotype classified 12.9% (12.4%) with an acute myocardial injury and 10.0% (13.1%) with an MI in the catheterized cohort (chart review cohort). Conclusions: Patients with two troponin measurements within 6 h, identified by our phenotype as having either an acute myocardial injury or MI, will at least meet the diagnostic criteria for an acute myocardial injury (barring lab errors) and indicate many previously uncaptured cases. Myocardial infarctions are harder to be certain of because ECG report findings might be superseded by evidence not included in our phenotype, or due to errors with the natural language processing. Full article
(This article belongs to the Special Issue Recent Advances in the Diagnosis and Treatment of Myocardial Infarction)
18 pages, 1742 KiB  
Article
Comparison of Outcomes Between ST-Segment Elevation and Non-ST-Segment Elevation Myocardial Infarctions Based on Left Ventricular Ejection Fraction
by Yong Hoon Kim, Ae-Young Her, Seung-Woon Rha, Cheol Ung Choi, Byoung Geol Choi, Soohyung Park, Su Jin Hyun, Jung Rae Cho, Min-Woong Kim, Ji Young Park and Myung Ho Jeong
J. Clin. Med. 2024, 13(22), 6744; https://doi.org/10.3390/jcm13226744 - 9 Nov 2024
Viewed by 1161
Abstract
Background: This study was conducted to address the lack of reports comparing the clinical outcomes of non-ST-segment elevation myocardial infarction (NSTEMI) and STEMI based on left ventricular ejection fraction (LVEF). Methods: A total of 9854 patients from the Korea Acute Myocardial [...] Read more.
Background: This study was conducted to address the lack of reports comparing the clinical outcomes of non-ST-segment elevation myocardial infarction (NSTEMI) and STEMI based on left ventricular ejection fraction (LVEF). Methods: A total of 9854 patients from the Korea Acute Myocardial Infarction Registry-National Institute of Health dataset were classified into three LVEF categories: heart failure (HF) with reduced ejection fraction (EF) (HFrEF, n = 1250), HF with mildly reduced EF (HFmrEF, n = 2383), and HF with preserved EF (HFpEF, n = 6221). Each group was further divided into NSTEMI and STEMI groups. The primary clinical outcome was the incidence of patient-oriented composite outcomes, defined as all-cause death, recurrent myocardial infarction, any repeat coronary revascularization, hospitalization for HF, and stroke. Results: Following adjustment, in-hospital mortality rates were comparable between the NSTEMI and STEMI groups in the HFrEF and HFmrEF groups. However, 3-year mortality rates were higher in the NSTEMI group. In contrast, in the HFpEF group, the STEMI group had higher rates of in-hospital all-cause death (p = 0.001) and cardiac death (p < 0.001) compared to the NSTEMI group, which was associated with increased 3-year all-cause death (p = 0.026) and cardiac death (p < 0.001) in the STEMI group. When in-hospital mortality was excluded, no difference in 3-year mortality rates was observed between the NSTEMI and STEMI groups in the HFpEF group. Conclusions: In-hospital mortality and 3-year outcomes varied across LVEF groups. Therefore, comparing NSTEMI and STEMI based on LVEF provides valuable insights into the differences in patient outcomes. Full article
(This article belongs to the Special Issue Recent Advances in the Diagnosis and Treatment of Myocardial Infarction)
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Review

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15 pages, 1404 KiB  
Review
Bleeding Risk in Elderly Patients Undergoing Percutaneous Coronary Intervention: A Comprehensive Review
by Alexander Marschall, Fernando Rivero, David del Val, Teresa Bastante, Edurne López Soberón, Inés Gómez Sánchez, Elena Basabe Velasco, Fernando Alfonso, José María de la Torre Hernández and David Martí Sánchez
J. Clin. Med. 2025, 14(4), 1194; https://doi.org/10.3390/jcm14041194 - 12 Feb 2025
Viewed by 688
Abstract
The care of elderly patients with coronary artery disease (CAD) undergoing percutaneous coronary interventions (PCIs) presents unique challenges due to age-related physiological and functional changes. With the global population aging rapidly, this demographic change affects a growing proportion of individuals requiring PCI. However, [...] Read more.
The care of elderly patients with coronary artery disease (CAD) undergoing percutaneous coronary interventions (PCIs) presents unique challenges due to age-related physiological and functional changes. With the global population aging rapidly, this demographic change affects a growing proportion of individuals requiring PCI. However, advanced age is associated with increased susceptibility to ischemic and bleeding complications, driven by physiological changes such as altered coagulation, vascular stiffness, and declining organ function. These factors complicate the management of CAD, making the balance between reducing thrombotic events and minimizing bleeding risks particularly challenging. Antiplatelet therapy is central to post-PCI management, but its benefits and risks differ significantly in elderly patients compared to younger populations. Tools like the PRECISE-DAPT and ARC-HBR provide guidance on dual antiplatelet therapy duration and bleeding risk stratification. However, their applicability and predictive accuracy in elderly patients remain areas of active investigation. This underscores the need for improved risk assessment methods tailored to the unique needs of aging individuals. In this review, we explore the epidemiological, pathophysiological, and clinical aspects of CAD in elderly patients, emphasizing the impact of aging on disease presentation and outcomes. Furthermore, we assess current risk stratification tools and discuss their limitations in predicting adverse events in older populations. By synthesizing these insights, we aim to highlight the complexities of managing elderly CAD patients and identify opportunities for optimizing personalized care to achieve better outcomes in this vulnerable group. Full article
(This article belongs to the Special Issue Recent Advances in the Diagnosis and Treatment of Myocardial Infarction)
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22 pages, 1759 KiB  
Review
State of the Art of Primary PCI: Present and Future
by Andrea Mignatti, Julio Echarte-Morales, Matteo Sturla and Azeem Latib
J. Clin. Med. 2025, 14(2), 653; https://doi.org/10.3390/jcm14020653 - 20 Jan 2025
Cited by 1 | Viewed by 2666
Abstract
Primary percutaneous coronary intervention (PCI) has revolutionized the management of ST-elevation myocardial infarction (STEMI), markedly improving patient outcomes. Despite technological advancements, pharmacological innovations, and refined interventional techniques, STEMI prognosis remains burdened by a persistent incidence of cardiac death and heart failure (HF), with [...] Read more.
Primary percutaneous coronary intervention (PCI) has revolutionized the management of ST-elevation myocardial infarction (STEMI), markedly improving patient outcomes. Despite technological advancements, pharmacological innovations, and refined interventional techniques, STEMI prognosis remains burdened by a persistent incidence of cardiac death and heart failure (HF), with mortality rates plateauing over the last decade. This review examines current practices in primary PCI, focusing on critical factors influencing patient outcomes. Moreover, it explores future developments, emphasizing the role of microvascular dysfunction—a critical but often under-recognized contributor to adverse outcomes, including incident HF and mortality, and has emerged as a key therapeutic frontier. Strategies aimed at preserving microvascular function, mitigating ischemia–reperfusion injury, and reducing infarct size are discussed as potential avenues for improving STEMI management. By addressing these challenges, the field can advance toward more personalized and effective interventions, potentially breaking the current deadlock in mortality rates and improving longer-term prognosis. Full article
(This article belongs to the Special Issue Recent Advances in the Diagnosis and Treatment of Myocardial Infarction)
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22 pages, 1721 KiB  
Review
Review of Advancements in Managing Cardiogenic Shock: From Emergency Care Protocols to Long-Term Therapeutic Strategies
by Amaia Martínez León, Pablo Bazal Chacón, Lorena Herrador Galindo, Julene Ugarriza Ortueta, María Plaza Martín, Pablo Pastor Pueyo and Gonzalo Luis Alonso Salinas
J. Clin. Med. 2024, 13(16), 4841; https://doi.org/10.3390/jcm13164841 - 16 Aug 2024
Viewed by 5498
Abstract
Cardiogenic shock (CS) is a complex multifactorial clinical syndrome of end-organ hypoperfusion that could be associated with multisystem organ failure, presenting a diverse range of causes and symptoms. Despite improving survival in recent years due to new advancements, CS still carries a high [...] Read more.
Cardiogenic shock (CS) is a complex multifactorial clinical syndrome of end-organ hypoperfusion that could be associated with multisystem organ failure, presenting a diverse range of causes and symptoms. Despite improving survival in recent years due to new advancements, CS still carries a high risk of severe morbidity and mortality. Recent research has focused on improving early detection and understanding of CS through standardized team approaches, detailed hemodynamic assessment, and selective use of temporary mechanical circulatory support devices, leading to better patient outcomes. This review examines CS pathophysiology, emerging classifications, current drug and device therapies, standardized team management strategies, and regionalized care systems aimed at optimizing shock outcomes. Furthermore, we identify gaps in knowledge and outline future research needs. Full article
(This article belongs to the Special Issue Recent Advances in the Diagnosis and Treatment of Myocardial Infarction)
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