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Acute Coronary Syndromes: From Diagnosis to Treatment
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Acute Coronary Syndromes: From Diagnosis to Treatment

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

Deadline for manuscript submissions: closed (25 February 2026) | Viewed by 20156

Special Issue Editors

Dr. Andreas Mitsis

E-Mail Website
Guest Editor
Department of Cardiology, Nicosia General Hospital, State Health Services Organization, 2029 Nicosia, Cyprus
Interests: interventional cardiology; percutaneous coronary intervention (PCI); acute myocardial infarction; acute coronary syndromes; transcatheter interventions; structural interventions; cardiovascular diseases; advanced coronary imaging techniques
Special Issues, Collections and Topics in MDPI journals
Dr. Christos Eftychiou

E-Mail Website
Guest Editor
Department of Cardiology, Nicosia General Hospital, State Health Services Organization, 2029 Nicosia, Cyprus
Interests: interventional cardiology; percutaneous coronary intervention (PCI); acute myocardial infarction; acute coronary syndromes; transcatheter interventions; structural interventions; cardiovascular diseases; advanced coronary imaging techniques
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

We are pleased to invite you to contribute to the Special Issue “Acute Coronary Syndrome: From Diagnosis to Treatment” in the Journal of Clinical Medicine. Acute Coronary Syndrome (ACS) remains one of the leading causes of morbidity and mortality worldwide, presenting ongoing challenges in early diagnosis, effective treatment, and long-term management. Recent advancements in biomarker research, imaging modalities, and interventional techniques have significantly transformed ACS management, yet many gaps remain.

This Special Issue aims to collect high-impact research and comprehensive reviews that address these gaps, providing insights into innovative diagnostic strategies, novel therapeutic approaches, and multidisciplinary management frameworks. We seek to foster collaboration and share advancements that can shape clinical practices and improve patient outcomes.

Scope and Themes:

  • Advanced risk stratification and the role of biomarkers in early diagnosis;
  • Innovations in imaging technologies for ACS detection and intervention;
  • Efficacy and safety of emerging pharmacological and interventional treatments;
  • Management of ACS in special populations (e.g., the elderly and patients with comorbidities);
  • Strategies for optimizing long-term care and patient adherence;
  • Health system interventions and quality improvement in ACS care.

We welcome original research articles, clinical trials, and expert reviews. We look forward to receiving your valuable contributions.

Dr. Andreas Mitsis
Dr. Christos Eftychiou
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 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

  • acute coronary syndrome
  • diagnosis
  • biomarkers
  • interventional cardiology
  • imaging
  • pharmacotherapy
  • patient management
  • health systems
  • special populations
  • clinical trials

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Related Special Issue

Published Papers (6 papers)

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Research

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12 pages, 250 KB  
Article
Sex-Related Differences in Predictors of Acute Coronary Syndrome in Kosovo: A Cross-Sectional Study
by Vesa Hoxha, Endrit Dragusha, Shqiponjë Morina, Enera Dragusha, Shpetim Thaqi, Michael Y. Henein and Ibadete Bytyçi
J. Clin. Med. 2025, 14(22), 8002; https://doi.org/10.3390/jcm14228002 - 11 Nov 2025
Viewed by 785
Abstract
Background/Objectives: Acute coronary syndrome (ACS) in old people is a growing global health problem, with high incidence and mortality. The aim of this study was to assess the cardiovascular risk factors in older patients with ACS, with particular emphasis on sex differences. [...] Read more.
Background/Objectives: Acute coronary syndrome (ACS) in old people is a growing global health problem, with high incidence and mortality. The aim of this study was to assess the cardiovascular risk factors in older patients with ACS, with particular emphasis on sex differences. Methods: We retrospectively analyzed 1482 patients with ACS (1184 old patients; men ≥ 55 years and women ≥ 65 years) and 298 young ACS patients (men ≤ 55 years and women ≤ 65 years) from University Clinical Centre of Kosovo. Data on cardiovascular risk factors, echocardiographic, electrocardiographic, angiographic indices and medications were collected from medical records. Results: Old ACS patients had higher prevalence of diabetes (50.1 vs. 34.6%; p < 0.001), hypertension (79.8 vs. 42.8; p < 0.001), multivessel coronary artery disease (88.6 vs. 22.1%; p < 0.001) but less prevalent hypercholesterolemia (31.5 vs. 48.2; p < 0.001), smoking, family history of coronary artery disease and other noncardiac risk factors compared with young ACS patients (p < 0.05, for all). Older women smoked less (26.3 vs. 41.1; p < 0.001) and drank less alcohol (0.8 vs. 6.8%; p < 0.001) but had higher prevalence of uncontrolled diabetes, arterial hypertension and hypercholesterolemia (p < 0.05 for all) compared with older males. Family history for coronary artery disease (CAD) was not significant between groups. Multivariate analysis revealed uncontrolled diabetes (OR = 2.26; 95% CI: 1.104–3.989; p < 0.001) and having three or more cardiac risk factors (OR = 3.141; 95% CI: 2.166–4.406; p < 0.001) as the strongest independent predictors of ACS in old patients. These associations remained significant when stratified by gender, with even stronger impact in female (uncontrolled diabetes OR = 2.942, 95% CI: 1.644–4.890; p < 0.001; ≥3 risk factors OR = 2.821; 95% CI: 1.782–4.436; p < 0.001) and in males who smoked (OR: 2.381, 95% CI: 1.109–2.981; p < 0.001). Conclusions: Uncontrolled diabetes and multiple cardiovascular risk factors are key contributors to ACS in older adults. Early identification and management of these risk factors are essential in reducing the burden of CAD older patients. Full article
(This article belongs to the Special Issue Acute Coronary Syndromes: From Diagnosis to Treatment)
14 pages, 232 KB  
Article
Retrospective Analysis of the Epidemiological and Clinical Characteristics of Acute Coronary Syndrome in a Tertiary Hospital Located at High Altitude
by Vladimir E. Ullauri-Solórzano, Christian Humberto Fierro Renoy, Juan Carlos Gaibor Barba, Diana Moreira-Vera, Henrry Oswaldo Jaramillo Prado, Ana Gabriela Finke Barriga, Víctor Arias Adriano, Francisco Xavier Castro Vega, Ana Cristina Chiliquinga, Kateherine Fonte Melendres, Luis Felipe Varela Pólit, Estefanía Chediak Pérez, Paulina Elizabeth Arteaga Yépez, Luis Alberto Paucar Rojas, Juan S. Izquierdo-Condoy, Jorge Vasconez-Gonzalez and Esteban Ortiz-Prado
J. Clin. Med. 2025, 14(17), 6232; https://doi.org/10.3390/jcm14176232 - 3 Sep 2025
Cited by 1 | Viewed by 1494
Abstract
Background: Cardiovascular diseases (CVDs) are the leading global cause of death, responsible for 17.9 million deaths annually (32%) as of 2019. Acute coronary syndrome (ACS) significantly contributes to this burden, particularly in low- and middle-income countries. In Latin America, ACS accounts for 35% [...] Read more.
Background: Cardiovascular diseases (CVDs) are the leading global cause of death, responsible for 17.9 million deaths annually (32%) as of 2019. Acute coronary syndrome (ACS) significantly contributes to this burden, particularly in low- and middle-income countries. In Latin America, ACS accounts for 35% of deaths. In Ecuador, 36,058 deaths were reported between 2019 and 2021, underscoring its significant public health impact. Objectives: This study aimed to determine the epidemiological, clinical, and hospital management characteristics of ACS patients admitted to the Metropolitan Hospital of Quito, located at high altitude, from January 2021 to October 2023. Methodology: A retrospective observational study analyzed anonymized medical records of 133 ACS patients treated at a tertiary care hospital in Quito. Results: Among 133 ACS patients, 72.9% were male, with a mean age of 68.9 ± 13.9 years. Overweight was prevalent, with a mean BMI of 26.6 ± 3.0 kg/m2. Hypertension (51.9%) and type 2 diabetes mellitus (26.3%) were common comorbidities. ST-segment elevation myocardial infarction (STEMI) was the most frequent ACS type (48.9%), followed by non-ST-segment elevation myocardial infarction (NSTEMI) (33.8%). Most patients (72.2%) underwent stent placement. Mortality was low (2.3%) and significantly associated with the presence of immunologic diseases (p = 0.015), TIMI risk score Grade IV (p = 0.009), and cardiac arrest on admission (p < 0.001). Conclusions: This study provides critical insights into the epidemiology and management of ACS in a high-altitude urban setting, emphasizing the importance of timely diagnosis and evidence-based therapies in improving patient outcomes. Full article
(This article belongs to the Special Issue Acute Coronary Syndromes: From Diagnosis to Treatment)
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Review

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17 pages, 316 KB  
Review
Alcohol Consumption and Acute Coronary Syndrome: Epidemiology, Pathophysiology, and Clinical Perspectives
by Panagiotis Iliakis, Eleftheria Stamou, Angeliki Vakka, Konstantina Ntalekou, Maria Kouremeti, Nikolaos Ktenopoulos, Paschalis Karakasis, Panagiotis Theofilis, Anna Pitsillidi, Athanasios Sakalidis, Kyriakos Dimitriadis, Christina Chrysochoou and Konstantinos Tsioufis
J. Clin. Med. 2026, 15(1), 299; https://doi.org/10.3390/jcm15010299 - 30 Dec 2025
Cited by 1 | Viewed by 1408
Abstract
Alcohol consumption is a globally prevalent lifestyle factor with complex and sometimes paradoxical effects on cardiovascular health, particularly regarding acute coronary syndrome (ACS). Earlier epidemiological studies described a J-shaped relationship between alcohol consumption and ACS risk; however, emerging evidence has increasingly challenged the [...] Read more.
Alcohol consumption is a globally prevalent lifestyle factor with complex and sometimes paradoxical effects on cardiovascular health, particularly regarding acute coronary syndrome (ACS). Earlier epidemiological studies described a J-shaped relationship between alcohol consumption and ACS risk; however, emerging evidence has increasingly challenged the validity of this concept. Mendelian randomization studies, genetic data, and recent pooled analyses suggest that the apparent cardioprotective effects of light-to-moderate drinking are largely attributable to residual confounding, including abstainer bias and socioeconomic factors, rather than true causal mechanisms. In contrast, excessive alcohol intake is linked to increased oxidative stress, inflammation, hypertension, and prothrombotic states, all of which contribute to plaque instability and the precipitation of ACS. Additionally, acute heavy drinking episodes may induce coronary vasospasm and arrhythmias, further elevating ACS risk. Genetic factors, drinking patterns, and beverage types may also modulate the relationship between alcohol and ACS, indicating the need for personalized risk assessment. Understanding these complex interactions is essential for clinicians when counseling patients on alcohol consumption within the context of cardiovascular prevention. This review aims to delve into current evidence on the epidemiology and pathophysiology linking alcohol consumption with ACS, providing a nuanced perspective that balances potential protective effects with the significant risks associated with excessive alcohol use, as well as summarizing all medical societies’ recommendations regarding alcohol consumption and cardiovascular health. Full article
(This article belongs to the Special Issue Acute Coronary Syndromes: From Diagnosis to Treatment)
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26 pages, 2236 KB  
Review
Acute Coronary Syndromes: State-of-the-Art Diagnosis, Management, and Secondary Prevention
by Xun Yuan, Stephan Nienaber, Ibrahim Akin, Tito Kabir and Christoph A. Nienaber
J. Clin. Med. 2026, 15(1), 16; https://doi.org/10.3390/jcm15010016 - 19 Dec 2025
Viewed by 7797
Abstract
Background: Acute coronary syndromes (ACSs) remain a leading cause of death and disability. Since the publication of the 2023 ESC ACS guidelines, multiple studies and an ESC/EAS dyslipidaemia update have refined how clinicians diagnose, revascularize, and treat ACS across the care continuum. Content: [...] Read more.
Background: Acute coronary syndromes (ACSs) remain a leading cause of death and disability. Since the publication of the 2023 ESC ACS guidelines, multiple studies and an ESC/EAS dyslipidaemia update have refined how clinicians diagnose, revascularize, and treat ACS across the care continuum. Content: This state-of-the-art review synthesizes advances from 2023 to 2025 across five domains. Diagnosis: High-sensitivity troponin-based accelerated pathways remain foundational; GRACE 3.0 improves calibration for early vs. delayed angiography, while selective use of CCTA and routine use of intracoronary imaging/physiology help define the mechanism and optimize PCI. Revascularization: complete revascularization continues to underpin care in multivessel disease, with recent data favouring culprit-only PCI acutely and staged non-culprit treatment during the index stay in most STEMI presentations, particularly with heart-failure physiology. Antithrombotic therapy: Aspirin remains critical early after ACS-PCI; emerging evidence supports shorter DAPT and aspirin withdrawal after 1 month in carefully selected, low-ischaemic-risk patients, whereas day-0 aspirin-free strategies in unselected ACS are not non-inferior. Secondary prevention: A “strike early and strong” approach to LDL-cholesterol—often with combination therapy in hospital—is emphasized, alongside nuanced roles for SGLT2 inhibitors and GLP-1 receptor agonists. Special populations and implementation: Sex- and age-aware tailoring (including MINOCA/SCAD evaluation), pragmatic bleeding-risk mitigation, digitally enabled cardiac rehabilitation, and registry-driven quality improvement translate evidence into practice. Summary: Contemporary ACS care is moving from uniform protocols toward risk-stratified, mechanism-informed pathways. We offer practical algorithms and checklists to align interventional timing, antithrombotic intensity/duration, and secondary prevention with individual patient risk—bridging new evidence to bedside decisions. Full article
(This article belongs to the Special Issue Acute Coronary Syndromes: From Diagnosis to Treatment)
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21 pages, 2211 KB  
Review
A Novel Protocol for Feasibility and Safety in Early Discharge with ACS
by Karim Jamhour-Chelh
J. Clin. Med. 2025, 14(23), 8373; https://doi.org/10.3390/jcm14238373 - 25 Nov 2025
Viewed by 938
Abstract
Acute coronary syndrome is the primary reason for admission to cardiology services and involves significant resource consumption. Currently, low-risk patients are recommended for discharge within the first 48–72 h, enabling early initiation of cardiac rehabilitation with proper follow-up. This is crucial not only [...] Read more.
Acute coronary syndrome is the primary reason for admission to cardiology services and involves significant resource consumption. Currently, low-risk patients are recommended for discharge within the first 48–72 h, enabling early initiation of cardiac rehabilitation with proper follow-up. This is crucial not only as an efficiency marker but also because current evidence has shown it to be a safe and feasible strategy. Thus, this work aims to provide a comprehensive review of the current evidence on early discharge in acute coronary syndrome and propose a new, intuitive, objective, and easy-to-use tool: the LATE2ACS protocol. This is a narrative, hypothesis-generating review; LATE2ACS is presented as a preliminary, exploratory checklist rather than a definitive or implementable score. Its added value lies in operationalizing post-PCI early discharge decision-making across ACS as a pragmatic bedside checklist that complements, rather than replaces, prognostic scores such as TIMI, GRACE, Zwolle, and CADILLAC. Full article
(This article belongs to the Special Issue Acute Coronary Syndromes: From Diagnosis to Treatment)
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18 pages, 587 KB  
Review
The Role of C-Reactive Protein in Acute Myocardial Infarction: Unmasking Diagnostic, Prognostic, and Therapeutic Insights
by Andreas Mitsis, Stefanos Sokratous, Georgia Karmioti, Michaela Kyriakou, Michail Drakomathioulakis, Michael M. Myrianthefs, Christos Eftychiou, Nikolaos P. E. Kadoglou, Stergios Tzikas, Nikolaos Fragakis and George Kassimis
J. Clin. Med. 2025, 14(13), 4795; https://doi.org/10.3390/jcm14134795 - 7 Jul 2025
Cited by 9 | Viewed by 6922
Abstract
C-reactive protein (CRP) has emerged as a valuable biomarker in acute myocardial infarction (AMI), offering multiple insights into diagnosis, prognosis, and therapeutic strategies. In the diagnostic domain, elevated CRP levels serve as an early indicator of AMI, aiding in prompt identification and initiation [...] Read more.
C-reactive protein (CRP) has emerged as a valuable biomarker in acute myocardial infarction (AMI), offering multiple insights into diagnosis, prognosis, and therapeutic strategies. In the diagnostic domain, elevated CRP levels serve as an early indicator of AMI, aiding in prompt identification and initiation of treatment. Prognostically, CRP is a strong predictor of adverse outcomes post-AMI, correlating with increased mortality and cardiovascular events. Beyond its diagnostic and prognostic roles, CRP also exposes therapeutic avenues in AMI management. Targeting CRP through pharmacological interventions has shown promise in reducing inflammatory responses, thereby mitigating myocardial damage and improving clinical outcomes. However, CRP’s low specificity, influenced by elevation in non-cardiac conditions, remains a clinical limitation that warrants consideration. This review comprehensively examines the evolving role of CRP in AMI, exploring its diagnostic accuracy, prognostic significance, and potential as a therapeutic target. The understanding of the complex role of CRP in AMI provides clinicians with valuable tools for risk stratification, treatment optimization, and personalized patient care in the acute setting. Full article
(This article belongs to the Special Issue Acute Coronary Syndromes: From Diagnosis to Treatment)
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