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Acute Coronary Syndrome (ACS): Guidelines and Evolving Concepts in the Diagnosis, Treatment and Management

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

Deadline for manuscript submissions: closed (31 October 2024) | Viewed by 21665

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Special Issue Editors

Dr. Giuseppe Andò

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Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
Interests: acute coronary syndrome; percutaneous coronary intervention (PCI); guidelines; oral anticoagulants (OAC); atrial fibrillation
Special Issues, Collections and Topics in MDPI journals

Dr. Francesco Costa

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Guest Editor

Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
Interests: acute coronary syndrome; percutaneous coronary intervention (PCI); guidelines; dual antiplatelet therapy (DAPT); risk scores; high bleeding risk patients

Dr. Antonio Micari

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Guest Editor

Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Messina, Italy
Interests: acute coronary syndrome; percutaneous coronary intervention (PCI); carotid artery disease; peripheral artery disease; drug-eluting balloons; structural cardiac interventions

Special Issue Information

Dear Colleagues,

There has been considerable progress in the management of ACS over the last twenty years. The understanding of the pathophysiology of intracoronary thrombosis from plaque erosion or rupture has paved the way for the evaluation of potent antithrombotic agents in the setting of ACS. Progressive developments in techniques and technologies for percutaneous coronary intervention have dramatically improved procedural effectiveness and safety and patients’ outcomes. However, acute presentations of coronary artery disease and their late consequences remain a leading cause of morbidity and mortality. While guidelines issued by scientific societies (1) summarize and evaluate available evidence to facilitate clinicians in their decision making for daily practice and (2) provide quality indicators to evaluate the implementation of proposed recommendations, continuously evolving research introduces new diagnostic algorithms and challenges therapeutic concepts. The present Special Issue has been conceived to provide an overview of the latest evidence in the field of ACS, focusing on both diagnostic and therapeutic advances and highlighting their implications for patients’ prognosis. Therefore, we welcome the submission of review articles as well as original research papers dealing with the topics of diagnostic and therapeutic advances in patients with ACS.

Dr. Giuseppe Andò
Dr. Francesco Costa
Dr. Antonio Micari
Guest Editors

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Keywords

percutaneous coronary intervention (PCI)
high-sensitivity cardiac troponins
cardiogenic shock
ST-elevation myocardial infarction (STEMI)
non-st-elevation acute coronary syndrome (NSTE-ACS)
coronary artery disease
dual antiplatelet therapy (DAPT)
oral anticoagulants (OAC)
atrial fibrillation

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Published Papers (7 papers)

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Editorial

Jump to: Research, Review

3 pages, 170 KiB

Open AccessEditorial

Advances in Acute Coronary Syndromes: Bridging Gaps in Diagnosis and Treatment

by Giuseppe Andò, Antonio Micari and Francesco Costa

J. Clin. Med. 2024, 13(19), 6003; https://doi.org/10.3390/jcm13196003 - 9 Oct 2024

Viewed by 1005

Abstract

Acute coronary syndromes (ACS) have long posed a formidable challenge to cardiovascular care, despite significant advancements in both understanding and treatment over the last few decades [...] Full article

(This article belongs to the Special Issue Acute Coronary Syndrome (ACS): Guidelines and Evolving Concepts in the Diagnosis, Treatment and Management)

Research

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13 pages, 613 KiB

Open AccessArticle

Outcomes of NSTEMI Admissions and Significance of TIMI Scores: A Nationwide Analysis Using the National Inpatient Sample

by Vivek Joseph Varughese, James Pollock, Prem Patel, Chandler Richardson, Cara Joseph, Dominic Vacca and Hata Mujadzic

J. Clin. Med. 2025, 14(1), 171; https://doi.org/10.3390/jcm14010171 - 31 Dec 2024

Viewed by 906

Abstract

Background/Objectives: The main aim of this study is to analyze the outcomes of NSTEMI admissions and test the relevance of TIMI as a risk score in a real-world setting. We also examine any potential social or health care disparities involved with outcomes of NSTEMI admissions. This study also investigates factors associated with mortality in NSTEMI admissions and its correlation with heart catheterization during admission. Methods: NSTEMI admissions were analyzed using the National Inpatient Sample. TIMI scores were calculated for the admissions and their association with all-cause mortality was studied. Differences in mortality outcomes based on heart catheterization during admission were studied in the subgroup with a TIMI score > 2. Correlations between time to heart catheterization and all-cause mortality in NSTEMI admissions were analyzed. Results: No significant social or healthcare disparities were noted among outcomes for NSTEMI admissions. NSTEMI admissions with a calculated TIMI score > 2 had a statistically significant association with all-cause mortality during admission: odds ratio 1.33 (95% CI 1.23–1.43, p value: 0.00). The prevalence of mortality among NSTEMI admissions with a calculated TIMI score > 2 who did not undergo heart catheterization was higher with statistical significance (6.23%; 95% CI: 5.84–6.65%), when compared to admissions who underwent heart catheterization (2.41%; 95% CI: 2.25–2.59%). NSTEMI admissions with a calculated TIMI score > 2 who underwent catheterization on or beyond the fourth day of hospitalization had a statistically significant association with all-cause mortality during admission: odds ratio: 2.56 (95% CI: 2.31–2.83, p value: 0.00). Age at admission, presence of CKD and CHF were associated with mortality in NSTEMI admissions, with statistical significance. Conclusions: Based on the results of our analysis, no disparities in terms of race/sex/hospital location, etc., were seen for NSTEMI in-hospital outcomes. Admissions with a TIMI score > 2 had a statistically significant association with in-hospital mortality, after accounting for confounders. Among NSTEMI admissions with a TIMI score > 2, those who did not undergo heart catheterization during admission were found to have a higher prevalence of in-hospital mortality. No social or healthcare disparities were seen among admissions with TIMI score > 2 who did not undergo heart catheterization during admission. We also noted that NSTEMI admissions with a TIMI score > 2 who underwent heart catheterization on or beyond Day 4 of the initial admission were associated with higher mortality. Full article

(This article belongs to the Special Issue Acute Coronary Syndrome (ACS): Guidelines and Evolving Concepts in the Diagnosis, Treatment and Management)

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15 pages, 869 KiB

Open AccessArticle

Contemporary Predictors of Major Adverse Cardiovascular Events Following Percutaneous Coronary Intervention: A Nationally Representative US Sample

by Benjamin D. Horne, Nipun Atreja, John Venditto, Thomas Wilson, Joseph B. Muhlestein, Joshua R. St. Clair, Kirk U. Knowlton, Naeem D. Khan, Narinder Bhalla and Jeffrey L. Anderson

J. Clin. Med. 2024, 13(10), 2844; https://doi.org/10.3390/jcm13102844 - 11 May 2024

Cited by 1 | Viewed by 2594

Abstract

Background: Patient outcomes after percutaneous coronary intervention (PCI) have improved over the last 30 years due to better techniques, therapies, and care processes. This study evaluated contemporary predictors of post-PCI major adverse cardiovascular events (MACE) and summarized risk in a parsimonious risk prediction model. Methods: The Cardiovascular Patient-Level Analytical Platform (CLiPPeR) is an observational dataset of baseline variables and longitudinal outcomes from the American College of Cardiology’s CathPCI Registry^® and national claims data. Cox regression was used to evaluate 2–6 years of patient follow-up (mean: 2.56 years), ending in December 2017, after index PCI between 2012 and 2015 (N = 1,450,787), to examine clinical and procedural predictors of MACE (first myocardial infarction, stroke, repeat PCI, coronary artery bypass grafting, and mortality). Cox analyses of post-PCI MACE were landmarked 28 days after index PCI. Results: Overall, 12.4% (n = 179,849) experienced MACE. All variables predicted MACE, with cardiogenic shock, cardiac arrest, four diseased coronary vessels, and chronic kidney disease having hazard ratios (HRs) ≥ 1.50. Other major predictors of MACE were in-hospital stroke, three-vessel disease, anemia, heart failure, and STEMI presentation. The index revascularization and discharge prescription of aspirin, P2Y₁₂ inhibitor, and lipid-lowering medication had HR ≤ 0.67. The primary Cox model had c-statistic c = 0.761 for MACE versus c = 0.701 for the parsimonious model and c = 0.752 for the parsimonious model plus treatment variables. Conclusions: In a nationally representative US sample of post-PCI patients, predictors of longitudinal MACE risk were identified, and a parsimonious model efficiently encapsulated them. These findings may aid in assessing care processes to further improve care post-PCI outcomes. Full article

(This article belongs to the Special Issue Acute Coronary Syndrome (ACS): Guidelines and Evolving Concepts in the Diagnosis, Treatment and Management)

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12 pages, 1577 KiB

Open AccessArticle

The Impact of Emergency Department Arrival Time on Door-to-Balloon Time in Patients with ST-Segment Elevation Myocardial Infarction Receiving Primary Percutaneous Coronary Intervention

by Yu-Ting Hsiao, Jui-Fu Hung, Shi-Quan Zhang, Ya-Ni Yeh and Ming-Jen Tsai

J. Clin. Med. 2023, 12(6), 2392; https://doi.org/10.3390/jcm12062392 - 20 Mar 2023

Cited by 3 | Viewed by 5120

Abstract

Door-to-balloon (DTB) time significantly affects the prognosis of patients with ST-segment elevation myocardial infarction (STEMI). The effects of temporal differences in emergency department (ED) arrival time on DTB time and on different segments of DTB time remain inconclusive. Therefore, we performed a retrospective study in a tertiary hospital between January 2013 and December 2021 and investigated the relationship between a patient’s arrival time and both their DTB time and different segments of their DTB time. Of 732 STEMI patients, 327 arrived during the daytime (08:01–16:00), 268 during the evening (16:01–24:00), and 137 at night (00:01–08:00). Significantly higher odds of delay in DTB time were observed during the nighttime (adjusted odds ratio (aOR): 2.87; 95% confidence interval (CI): 1.50–5.51, p = 0.002) than during the daytime. This delay was mainly attributed to a delay in cardiac catheterization laboratory (cath lab) activation-to-arrival time (aOR: 6.25; 95% CI: 3.75–10.40, p < 0.001), particularly during the 00:00–04:00 time range. Age, sex, triage level, and whether patients arrived during the COVID-19 pandemic also had independent effects on different segments of DTB time. Further studies are required to investigate the root causes of delay in DTB time and to develop specific strategies for improvement. Full article

(This article belongs to the Special Issue Acute Coronary Syndrome (ACS): Guidelines and Evolving Concepts in the Diagnosis, Treatment and Management)

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14 pages, 1851 KiB

Open AccessArticle

GP IIb/IIIa Receptor Inhibitors in Mechanically Ventilated Patients with Cardiogenic Shock due to Myocardial Infarction in the Era of Potent P2Y12 Receptor Antagonists

by Vojko Kanic, Gregor Kompara and David Suran

J. Clin. Med. 2022, 11(24), 7426; https://doi.org/10.3390/jcm11247426 - 14 Dec 2022

Cited by 4 | Viewed by 1643

Abstract

Objective: To investigate the association between GP IIb/IIIa receptor inhibitors (GPI) and mortality and bleeding in patients with cardiogenic shock (CS) due to myocardial infarction (MI) who were mechanically ventilated on admission. Methods: We retrospectively divided 153 patients into two groups (with or without GPI). Thirty-day and one-year all-cause mortality and bleeding were studied. Results: The observed 30-day and one-year all-cause mortality were similar in both groups [54 (69.2%) with GPI vs. 62 (82.7%) without GPI; p = 0.06, and 60 (76.9%) with GPI vs. 64 (85.3%) without GPI; p = 0.22, respectively]. Patients with GPI suffered fewer unsuccessful PCI (TIMI 0/1 was 10% in the GPI group vs. 57% in the group without GPI), experienced more improvements in TIMI ≥ 1 flow [68 (87.2%) in the GPI group vs. 38 (50.7%) without GPI; p < 0.0001], and they achieved better cerebral performance category (CPC) scores (1.61 ± 0.99 with GPI vs. 2.76 ± 1.64 without GPI; p = 0.005). The bleeding rate was similar in patients with and without GPI [33 (42.3%) vs. 31 (41.3%): p = 1.00], in patients with P2Y12 receptor antagonists (P2Y12) [18 (46.1%) with GPI vs. 21 (46.7%) without GPI; p = 1.00], and in patients with potent P2Y12 [8 (30.8%) with GPI vs. 9 (37.5%) without GPI; p = 0.77]. Conclusions: Due to the study design (limited sample size, retrospective inclusion with high risk of selection bias), our analysis does not allow us to draw conclusions about the effectiveness of GPI in this context. Despite all these limitations, GPI were associated with improved TIMI flow after PCI in our multivariable model without increasing bleeding rates. In addition, better CPC scores were observed, but no association between GPI and outcome was found. Our analysis suggests that selective use of GPI may be beneficial in mechanically ventilated patients with MI in CS without additional bleeding risk, even in the era of potent P2Y12. Full article

(This article belongs to the Special Issue Acute Coronary Syndrome (ACS): Guidelines and Evolving Concepts in the Diagnosis, Treatment and Management)

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16 pages, 2004 KiB

Open AccessArticle

Incidence, Predictive Factors and Long-Term Clinical Impact of Left Ventricular Remodeling According to the Completeness of Revascularization in Patients with ST-Elevation Myocardial Infarction and Multivessel Disease

by Min Chul Kim, Yongwhan Lim, Youngkeun Ahn, Joon Ho Ahn, Seung Hun Lee, Dae Young Hyun, Kyung Hoon Cho, Doo Sun Sim, Young Joon Hong, Ju Han Kim and Myung Ho Jeong

J. Clin. Med. 2022, 11(21), 6252; https://doi.org/10.3390/jcm11216252 - 23 Oct 2022

Cited by 2 | Viewed by 2049

Abstract

In this study, we identified several factors related to left ventricular remodeling (LVR) and examined the impact of LVR on the prognosis of patients with ST-elevated myocardial infarction and multivessel disease treated with complete (CR) or incomplete (IR) revascularization. LVR was defined as an LV end-diastolic diameter >55 mm. A total of 262 patients without LVR at presentation were followed up with echocardiography between 1 month and 1 year. The primary outcome was a composite of all-cause death (AD), MI, and heart failure (HF), referred to as a major adverse cardiovascular endpoint (MACE). Then, each variable was analyzed as a secondary outcome. Follow-up echocardiography identified 26 patients (9.9%) with LVR. LVR was associated with an initial LV ejection fraction <50%, Killip 3 disease at presentation, and a peak troponin I level >70 mg/dL. Survival analysis showed an association between LVR and adverse outcomes only in the IR group, in which the adjusted hazard ratio (HR) was increased for the MACE (HR = 3.22, 95% confidence interval (CI) = 1.19–8.71, p = 0.002) and HF (HR = 21.37, 95% CI = 4.47–102.09, p< 0.001), but not for the CR group. In STEMI with MVD, LVR within the first year after percutaneous coronary intervention was associated with worse outcomes in the IR but not the CR group. Full article

(This article belongs to the Special Issue Acute Coronary Syndrome (ACS): Guidelines and Evolving Concepts in the Diagnosis, Treatment and Management)

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Review

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16 pages, 697 KiB

Open AccessReview

The Evolving Field of Acute Coronary Syndrome Management: A Critical Appraisal of the 2023 European Society of Cardiology Guidelines for the Management of Acute Coronary Syndrome

by Roberto Licordari, Francesco Costa, Victoria Garcia-Ruiz, Mamas A. Mamas, Guillaume Marquis-Gravel, Jose M. de la Torre Hernandez, Juan Jose Gomez Doblas, Manuel Jimenez-Navarro, Jorge Rodriguez-Capitan, Cristobal Urbano-Carrillo, Luis Ortega-Paz, Raffaele Piccolo, Antonio Giovanni Versace, Gianluca Di Bella, Giuseppe Andò, Dominick J. Angiolillo, Marco Valgimigli and Antonio Micari

J. Clin. Med. 2024, 13(7), 1885; https://doi.org/10.3390/jcm13071885 - 25 Mar 2024

Cited by 4 | Viewed by 6689

Abstract

Acute coronary syndromes (ACS), encompassing conditions like ST-elevation myocardial infarction (STEMI) and non-ST-elevation acute coronary syndromes (NSTE-ACS), represent a significant challenge in cardiovascular care due to their complex pathophysiology and substantial impact on morbidity and mortality. The 2023 European Society of Cardiology (ESC) guidelines for ACS management introduce several updates in key areas such as invasive treatment timing in NSTE-ACS, pre-treatment strategies, approaches to multivessel disease, and the use of imaging modalities including computed tomography (CT) coronary angiography, magnetic resonance imaging (MRI), and intracoronary imaging techniques, such as optical coherence tomography (OCT) and intravascular ultrasound (IVUS). They also address a modulation of antiplatelet therapy, taking into consideration different patient risk profiles, and introduce new recommendations for low-dose colchicine. These guidelines provide important evidence-based updates in practice, reflecting an evolution in the understanding and management of ACS, yet some potentially missed opportunities for more personalized care and technology adoption are discussed. Full article

(This article belongs to the Special Issue Acute Coronary Syndrome (ACS): Guidelines and Evolving Concepts in the Diagnosis, Treatment and Management)

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