Clinical Frontiers in Myocardial Infarction: From Acute Revascularization to Long-Term Secondary Prevention

Dear Colleagues,

It is my great pleasure and honor to introduce this Special Issue of MDPI, entitled “Clinical Frontiers in Myocardial Infarction: From Acute Revascularization to Long-Term Secondary Prevention.” The management of acute myocardial infarction has improved remarkably over recent decades, with contemporary reperfusion strategies, drug-eluting stents, and potent antiplatelet therapies substantially reducing early mortality and recurrent ischemic events. Despite these achievements, important challenges remain along the continuum of care, from the acute phase to long-term prevention.

One of the key areas of ongoing debate is the role of complete versus culprit-only revascularization. While several randomized trials have provided valuable insights, questions remain regarding the optimal timing, patient selection, and long-term prognostic benefit of complete revascularization strategies. Similarly, the concept of the “vulnerable plaque”—lesions prone to rupture and trigger future events—continues to evolve. Advances in intracoronary imaging, combined with refined biomarker and molecular profiling, offer new opportunities to better understand plaque biology and identify high-risk lesions beyond angiographic severity alone.

Equally important is the recognition that many patients remain at heightened cardiovascular risk even after successful PCI. Residual risk is often driven by factors such as systemic inflammation, endothelial dysfunction, microvascular disease, and progressive atherosclerosis. Emerging biomarkers, novel imaging techniques, and machine-learning–based approaches may allow earlier identification of patients at greatest risk, enabling a more personalized and aggressive pharmacological strategy for secondary prevention.

This Special Issue aims to highlight both the progress made and the critical gaps that remain in the treatment of myocardial infarction. We welcome original research and comprehensive reviews addressing complete revascularization strategies, mechanisms and detection of vulnerable plaque, and novel tools for risk stratification and secondary prevention. Our goal is to foster new insights that will help refine treatment strategies and improve long-term outcomes for patients worldwide.

Dr. Nikolaos Stalikas
Guest Editor

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