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Residual Risk in High-Risk Patients Undergoing Percutaneous Coronary Intervention

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

Deadline for manuscript submissions: 20 September 2026 | Viewed by 1502

Special Issue Editors


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Guest Editor
Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
Interests: cardiology; interventional cardiology; percutaneous coronary intervention; PCI; acute heart failure; myocardial infarction; acute heart failure

E-Mail Website
Guest Editor
Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
Interests: cardiology; precision medicine; residual risk; acute coronary syndrome; percutaneous coronary intervention; PCI
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Special Issue Information

Dear Colleagues,

Despite major advances in percutaneous coronary intervention (PCI) techniques and evidence-based pharmacological therapies, patients undergoing PCI—particularly those at high risk—continue to experience a substantial burden of residual cardiovascular risk. Recurrent ischemic events, bleeding complications, heart failure, and mortality remain frequent even in the era of contemporary stent platforms and optimized secondary prevention strategies. This residual risk reflects the complex interplay of residual lipid-related, thrombotic, metabolic, inflammatory, and polyvascular mechanisms that are often insufficiently captured by traditional risk stratification models.

This Special Issue aims to provide a comprehensive and clinically oriented overview of residual risk in high-risk patients undergoing PCI, focusing on emerging concepts, biomarkers, and therapeutic strategies to improve long-term outcomes. Topics of interest include, but are not limited to, lipoprotein(a) and other lipid abnormalities, antiplatelet treatment optimization and de-escalation strategies, glucose metabolism and continuous glucose monitoring, polyvascular and carotid artery disease, inflammation, advanced imaging, and personalized risk stratification approaches. Original research articles and state-of-the-art reviews addressing mechanisms, risk prediction, and tailored secondary prevention strategies are all welcome. By integrating multidimensional perspectives, this Special Issue aims to advance a more personalized and comprehensive approach to secondary prevention after PCI.

Dr. Giampiero Vizzari
Prof. Dr. Antonio Micari
Guest Editors

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Keywords

  • cardiology
  • precision medicine
  • residual risk
  • acute coronary syndrome
  • percutaneous coronary intervention
  • PCI

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Published Papers (1 paper)

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Review

20 pages, 2266 KB  
Review
Impact of Lipoprotein(a) on Residual Cardiovascular Risk After an Acute Coronary Syndrome
by Nelsa González-Aguado, Rafael Franco-Hita, Jose Ignacio Larrubia-Valle, Fernando Puyol-Ruiz, Ainhoa Robles-Mezcua, José Manuel García-Pinilla, María Jiménez-Salva, Alberto Piserra-López, Francisco Javier Pavon-Moron, Alejandro Pérez-Cabeza, Pierre Sabouret and Francesco Costa
J. Clin. Med. 2026, 15(5), 1688; https://doi.org/10.3390/jcm15051688 - 24 Feb 2026
Cited by 1 | Viewed by 1302
Abstract
Reducing residual cardiovascular risk following acute coronary syndrome (ACS) remains a major unmet clinical need. Despite substantial advances in lipid-lowering therapies, the risk of recurrent major adverse cardiovascular events (MACEs) after ACS remains high, with an estimated incidence of approximately 33.4% at 5 [...] Read more.
Reducing residual cardiovascular risk following acute coronary syndrome (ACS) remains a major unmet clinical need. Despite substantial advances in lipid-lowering therapies, the risk of recurrent major adverse cardiovascular events (MACEs) after ACS remains high, with an estimated incidence of approximately 33.4% at 5 years. Residual cardiovascular risk is driven by multiple mechanisms, including persistent inflammation, a prothrombotic status, metabolic disturbances, and the presence of atherogenic lipoproteins beyond low-density lipoprotein cholesterol (LDL-C). Lipoprotein(a) (Lp(a)) is a pro-inflammatory, prothrombotic, and pro-atherosclerotic lipoprotein that appears to play a major role in residual risk after ACS or ischemic stroke. Elevated Lp(a) is a well-established independent and causal risk factor for atherosclerotic cardiovascular disease (ASCVD). Nevertheless, evidence regarding its prognostic value specifically after ACS remains limited, with marked heterogeneity across studies, which complicates direct comparisons and interpretation. In addition, while Lp(a) levels are predominantly genetically determined, recent studies have reported intra-individual variability, although their clinical significance remains uncertain. Finally, current therapeutic options specifically targeting Lp(a) are limited. Novel RNA-based therapies, including antisense oligonucleotides, small interfering RNAs, and emerging gene-editing approaches, have demonstrated profound and sustained reductions in circulating Lp(a) levels. Yet, whether this biological effect translates into reductions in hard clinical endpoints is under evaluation in ongoing clinical trials. This review aims to synthesize current evidence on the role of Lp(a) as a major contributor to residual cardiovascular risk following ACS. Full article
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