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Acute Myocardial Infarction: Diagnosis, Treatment, and Rehabilitation

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

Deadline for manuscript submissions: 20 July 2026 | Viewed by 8838

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Dr. Francesca Giordana

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Division of Cardiology, Santa Croce and Carle Hospital, Cuneo, Italy
Interests: acute myocardial infarction; echocardiography; diagnostic coronary angiography; acute heart failure; transthoracic and transesophageal echocardiography
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Special Issue Information

Dear Colleagues,

The natural history of acute myocardial infarction (AMI) has been dramatically revolutionized by the introduction of coronary angioplasty at the end of the last century. This has led to a significant reduction of in-hospital mortality for these patients. On the other hand, the percentage of subjects with chronic heart failure (HF) has increased and despite the significant improvement in HF therapy, the rate of new events in the follow-up remains high. There are still many grey zones in this field that deserve to be explored in depth, both from the diagnostic and the therapeutic point of view. The most appropriate management of AMI type 2, the mechanical supports to be preferred in patients with cardiogenic shock, and the way in which to implement rehabilitation programs in the post-acute phase of AMI are just a few examples. Moreover, timely access to care and patient compliance remain critical challenges worldwide.

For these reasons, in this Special Issue, we encourage the submission of state-of-the-heart reviews and/or original articles that focus on this topic of current interest.

Dr. Francesca Giordana
Guest Editor

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Keywords

acute myocardial infarction
coronary angioplasty
acute heart failure
cardiogenic shock
rehabilitation programs

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Published Papers (7 papers)

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Research

Jump to: Review

17 pages, 998 KB

Open AccessArticle

Self-Reported Habitual Daily Physical Activity as an Independent Predictor of Coronary Artery Disease Extension in Patients with Myocardial Infarction: A Prospective Observational Study

by Corina Cinezan and Maria Luiza Hiceag

J. Clin. Med. 2026, 15(10), 3814; https://doi.org/10.3390/jcm15103814 - 15 May 2026

Viewed by 147

Abstract

Background: The extent of coronary artery disease (CAD) is a major determinant of prognosis in patients with myocardial infarction (MI). While structured exercise is known to be cardioprotective, the association between habitual daily physical activity and angiographic CAD extension remains insufficiently characterized. Methods: In this prospective observational study, 269 patients were hospitalized with acute MI underwent coronary angiography. Habitual daily physical activity during the four weeks preceding admission was assessed using 10-point self-reported daily preadmission effort questions to help the patients to report a final effort score. CAD extension was classified as single-, double- or triple-vessel disease. Differences in daily effort across CAD categories were evaluated using the Kruskal–Wallis test. Independent predictors of CAD extension were identified using ordinal logistic regression adjusted for age, sex, smoking, hypertension, diabetes mellitus, hyperlipidemia and body mass index. Results: Daily preadmission effort decreased progressively with increasing CAD severity (mean scores: 7.44 in single-vessel, 4.93 in double-vessel and 3.69 in triple-vessel disease; p < 0.0001). In multivariable ordinal logistic regression analysis, older age, hypertension, diabetes mellitus and hyperlipidemia were independently associated with greater CAD extension. Higher daily preadmission effort was strongly and independently associated with lower CAD severity; each one-point increase in effort score was associated with a 46% reduction in the odds of more extensive CAD (odds ratio 0.54, 95% confidence interval 0.45–0.64; p < 0.0001). Conclusions: Greater habitual daily physical activity prior to myocardial infarction is independently associated with less extensive coronary artery disease. Assessment of daily preadmission effort may provide clinically useful information regarding coronary disease burden and highlights the potential importance of everyday physical activity in cardiovascular prevention. These findings should be interpreted with caution given the use of a non-validated, self-reported measure of physical activity and the observational study design. Full article

(This article belongs to the Special Issue Acute Myocardial Infarction: Diagnosis, Treatment, and Rehabilitation)

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15 pages, 769 KB

Open AccessArticle

Early Predictors of In-Hospital Mortality and Cardiac Dysfunction in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Early Revascularization

by Corina Cinezan, Alexandra Manuela Buzle and Camelia Bianca Rus

J. Clin. Med. 2026, 15(9), 3256; https://doi.org/10.3390/jcm15093256 - 24 Apr 2026

Viewed by 209

Abstract

Background: Despite advances in reperfusion therapy, ST-segment elevation myocardial infarction (STEMI) remains associated with substantial morbidity and mortality. Early identification of predictors of adverse outcomes is essential for improving risk stratification. Methods: This retrospective study included 512 STEMI patients who underwent coronary revascularization within 6 h of symptom onset. Clinical, laboratory, angiographic and echocardiographic variables were analyzed. The primary endpoint was in-hospital mortality. Secondary outcomes included reduced left ventricular ejection fraction (LVEF < 40%) and moderate-to-severe ischemic mitral regurgitation (IMR). Independent predictors of in-hospital mortality were identified using multivariable logistic regression, while secondary outcomes were described to characterize the study population. Model performance was evaluated using ROC analysis. Results: In-hospital mortality occurred in 9.4% of patients. Reduced LVEF was present in 26.2%, and IMR in 10.9%. Independent predictors of mortality included LVEF < 40% (OR 5.72, 95% CI 2.77–11.80, p < 0.001), IMR (OR 2.61, 95% CI 1.14–5.97, p = 0.023), lower hemoglobin levels (OR 0.74, 95% CI 0.61–0.91, p = 0.003), and reduced glomerular filtration rate (OR 0.96, 95% CI 0.95–0.98, p < 0.001). The model demonstrated good discrimination (AUC 0.88). Complete revascularization was not independently associated with mortality. Conclusions: Left ventricular dysfunction, IMR, anemia, and renal impairment are strong predictors of in-hospital mortality in STEMI patients. Integrating echocardiographic and laboratory parameters may improve early risk stratification and guide clinical decision-making. Full article

(This article belongs to the Special Issue Acute Myocardial Infarction: Diagnosis, Treatment, and Rehabilitation)

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15 pages, 1742 KB

Open AccessArticle

Construction of a Nomogram Prediction Model for Mortality Risk Within 14 Days in Patients with Acute Myocardial Infarction and Ventricular Septal Rupture

by Jie Luo, Ben Huang, Hao-Yu Ruan, Du-Jiang Xie, Gao-Feng Wang, Lei Zhou, Ling Zhou and Shao-Liang Chen

J. Clin. Med. 2026, 15(8), 2919; https://doi.org/10.3390/jcm15082919 - 11 Apr 2026

Viewed by 475

Abstract

Objective: This study aimed to develop a nomogram prediction model for predicting 14-day in-hospital mortality in patients with acute myocardial infarction (AMI) and ventricular septal rupture (VSR). Methods: Clinical data of 86 hospitalized patients (44 survivors and 42 non-survivors within 14 days) were retrospectively collected in Nanjing First Hospital from 1 March 2015 to 7 August 2025. Lasso regression and multivariable logistic regression were used to identify predictors, which were subsequently incorporated into the nomogram development. The model performance was assessed using area under the receiver operating characteristic curve (AUC), calibration plots, decision curve analysis (DCA), and clinical impact curves, with internal validation via 1000 bootstrap resamples. Results: Analysis of lasso regression and multivariable logistic regression analysis identified WBC count (OR = 1.31, 95% CI: 1.01–1.28, p = 0.040), D-dimer level (OR = 1.18, 95% CI: 1.01–1.38, p = 0.043), early revascularization (OR = 0.22, 95% CI: 0.06–0.88, p = 0.032), ventilatory support (OR = 3.48, 95% CI: 1.07–11.29, p = 0.038), and infection (OR = 3.97, 95% CI: 1.02–15.42, p = 0.047) as independent predictors of 14-day mortality for patients. Based on the results, a prediction nomogram model was constructed. The model achieved an area under the receiver operating characteristic curve (AUC) of 0.866 (95% CI: 0.785–0.946), with sensitivity of 0.857 (95% CI: 0.751–0.963) and specificity of 0.818 (95% CI: 0.704–0.932). Calibration plots demonstrated acceptable agreement between predicted and observed probabilities; decision curve analysis (DCA) and clinical impact curve further confirmed its net benefit and clinical utility. By 1000 bootstrap resampling iterations, the model demonstrated an apparent AUC of 0.864, 95% CI: 0.776–0.938, confirming reasonable discriminative performance. Conclusions: In summary, this study developed a clinical interpretable nomogram to estimate short-term (14-day) in-hospital mortality risk in patients with AMI-VSR; it provides a robust and interpretable tool for predicting short-term in-hospital mortality. Full article

(This article belongs to the Special Issue Acute Myocardial Infarction: Diagnosis, Treatment, and Rehabilitation)

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17 pages, 6776 KB

Open AccessArticle

Prognostic Impact of Renin–Angiotensin System Inhibitors in Revascularized Patients with Acute Myocardial Infarction and Preserved or Mildly Reduced Ejection Fraction: A Retrospective Cohort Study

by Yanhua Yang, Minqi Liao, Xiaoyu Liu, Zhengwei Jian, Lihua Chen, Yongzhao Yao, Zhiming Yuan and Suxia Guo

J. Clin. Med. 2026, 15(7), 2676; https://doi.org/10.3390/jcm15072676 - 1 Apr 2026

Viewed by 527

Abstract

Background: The prognostic value of discharge renin–angiotensin–aldosterone system inhibitor (RASi) therapy in contemporary PCI-treated acute myocardial infarction (AMI) survivors with preserved or mildly reduced left ventricular ejection fraction (LVEF) remains uncertain. Methods: A retrospective cohort study of 2530 AMI patients (2019–2022) stratified by RASi use. Exclusion criteria were in-hospital mortality, LVEF < 40%, contraindications to the use of RASis or no percutaneous coronary intervention (PCI). Primary endpoints included heart failure (HF) events, recurrent acute coronary syndrome (ACS), and all-cause mortality. Kaplan–Meier analyses and inverse probability of treatment weighting (IPTW)-weighted Cox models were applied. Results: Over a mean follow-up of 49 months, discharge RASi therapy was not associated with all-cause mortality overall, but was associated with fewer HF rehospitalizations (HR 0.62, 95% CI 0.40–0.95; p = 0.03). Mortality associations differed by AMI type and hypertension status, particularly for NSTEMI (HR 0.36, 95% CI 0.14–0.91; p = 0.03; p for interaction = 0.02) and hypertension (HR 0.36, 95% CI 0.15–0.84; p = 0.02; p for interaction = 0.04). Conclusions: In this single-center observational cohort of PCI-treated AMI survivors with LVEF ≥ 40%, discharge RASi therapy was associated with fewer HF rehospitalizations but not with lower overall mortality. Exploratory subgroup analyses suggested potential heterogeneity according to NSTEMI status and hypertension, but these findings should be considered hypothesis-generating and require confirmation. Full article

(This article belongs to the Special Issue Acute Myocardial Infarction: Diagnosis, Treatment, and Rehabilitation)

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12 pages, 1397 KB

Open AccessArticle

Prediction of Cardiogenic Shock in Acute Myocardial Infarction Patients Using a Nomogram

by Jie Wang, Changying Zhao, Chuqing Yang, Yang Dong, Xiaohong Yang and Chaofeng Sun

J. Clin. Med. 2025, 14(24), 8789; https://doi.org/10.3390/jcm14248789 - 12 Dec 2025

Viewed by 795

Abstract

Background: Cardiogenic shock (CS) complicating acute myocardial infarction (AMI) is associated with a high mortality rate. Early identification of patients at risk for in-hospital CS is crucial for timely intervention. This study aimed to develop a risk prediction model for CS using admission data. Methods: This retrospective case–control study included AMI patients and classified them into case and control groups, based on the development of in-hospital CS. Clinical information at admission was obtained and 1:1 propensity score matching (PSM) was performed based on age, gender, and diagnosis of ST-elevation myocardial infarction. Factors with p < 0.10 at baseline were incorporated to identify the independent risk factors, which were further used to construct a predictive nomogram. Results: After PSM, 374 patients were finally enrolled in both groups. After relaxed least absolute shrinkage and selection operator and multivariate logistic regression, independent risk factors identified for CS in AMI patients included systolic blood pressure [odds ratio (OR): 0.866; 95% confidence interval (CI): 0.844–0.888, p < 0.001], diastolic blood pressure (OR: 1.031; 95% CI: 1.001–1.063, p = 0.046), triglycerides (OR: 0.561; 95% CI: 0.385–0.820, p = 0.003), creatinine (OR: 1.005; 95% CI: 1.000–1.010, p = 0.048), globulin (OR: 0.915; 95% CI: 0.862–0.972, p = 0.004), left ventricular ejection fraction (OR: 0.951; 95% CI: 0.928–0.975, p < 0.001), and coronary angiography (OR: 0.183; 95% CI: 0.058–0574, p = 0.004). The nomogram incorporating these variables demonstrated an area under the curve of 0.937 (95% CI: 0.952–0.967), indicating good discriminatory ability in the calibration curve and decision curve. Conclusions: Seven independent risk factors for CS in AMI patients were identified upon admission. The proposed nomogram might facilitate early risk stratification and guide clinical decision-making to improve outcomes. Full article

(This article belongs to the Special Issue Acute Myocardial Infarction: Diagnosis, Treatment, and Rehabilitation)

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Review

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24 pages, 2245 KB

Open AccessReview

Type 2 Myocardial Infarction: Navigating Diagnostic Pathways and Therapeutic Crossroads Between Invasive and Conservative Strategies

by Sebastian Cinconze, Chiara Bernelli and Francesca Giordana

J. Clin. Med. 2026, 15(3), 1279; https://doi.org/10.3390/jcm15031279 - 5 Feb 2026

Viewed by 2856

Abstract

Type 2 myocardial infarction (T2MI) is defined as myocardial necrosis caused by an imbalance between oxygen supply and demand in the absence of acute atherothrombotic coronary occlusion/erosion. Unlike type 1 myocardial infarction (T1MI), T2MI comprises a heterogeneous group of clinical scenarios, often triggered by systemic or cardiac conditions, and it frequently affects elderly patients with a high burden of comorbidities. T2MI often underline multivessel coronary artery disease and, despite its growing clinical relevance, the diagnostic and therapeutic approach to T2MI remains challenging and lacks standardized recommendations. In this review, we present an updated and a comprehensive synthesis of current evidence on the diagnosis and management of T2MI, focusing on the role of coronary angiography and interventional strategies. We discuss the utility of high-sensitivity cardiac biomarkers, imaging modalities, and clinical risk scores to guide patient selection for invasive evaluation. Specific attention is given to conservative and alternative revascularization approaches—including drug-coated balloon angioplasty and stentless percutaneous coronary intervention (PCI)—in frail and high-bleeding-risk patients. The review emphasizes the need for individualized decision-making in a population where standard invasive strategies may not always be appropriate, and where a tailored balance between ischemic and hemorrhagic risk is crucial. Full article

(This article belongs to the Special Issue Acute Myocardial Infarction: Diagnosis, Treatment, and Rehabilitation)

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19 pages, 1119 KB

Open AccessReview

Percutaneous Mechanical Circulatory Support Devices in Cardiogenic Shock: A Narrative Review in Light of Recent Evidence

by Vincenzo Paragliola, Marco Gamardella, Luca Franchin, Maurizio Bertaina, Francesco Colombo, Paola Zanini, Salvatore Colangelo, Pierluigi Sbarra, Giacomo Boccuzzi and Mario Iannaccone

J. Clin. Med. 2025, 14(21), 7731; https://doi.org/10.3390/jcm14217731 - 30 Oct 2025

Cited by 1 | Viewed by 3193

Abstract

Cardiogenic shock (CS) is a complex, life-threatening syndrome characterized by inadequate tissue perfusion due to impaired cardiac function. Acute myocardial infarction (AMI) and acute decompensated heart failure are the leading causes, with mortality remaining high despite advances in revascularization and supportive care. The Society for Cardiovascular Angiography and Interventions (SCAI) classification allows risk stratification and guides clinical decision making by capturing the spectrum of shock severity. Percutaneous mechanical circulatory support (pMCS) devices, such as the intra-aortic balloon pump (IABP) and Impella, aim to stabilize hemodynamics by augmenting cardiac output and unloading the left ventricle. However, randomized trials and meta-analyses have not demonstrated a consistent survival advantage of Impella over IABP, while reporting higher rates of bleeding and vascular complications. Landmark trials, including ECLS-SHOCK and DanGer, have provided conflicting results, likely reflecting differences in baseline severity and timing of device implantation. Veno-arterial extracorporeal membrane oxygenator (VA-ECMO) offers full cardiopulmonary support but increases left ventricular afterload, potentially worsening myocardial injury. Combined strategies such as ECPELLA (Impella + VA-ECMO) or ECMO + IABP may mitigate left ventricle (LV) overload and improve bridging to recovery or advanced therapies, although evidence remains largely observational and complication rates are considerable. In right-sided or biventricular failure, tailored options (e.g., Impella RP, Bi-Pella) guided by invasive hemodynamics may be required. Current evidence suggests that pMCS benefits are limited to carefully selected subgroups, underscoring the importance of early diagnosis, prompt referral, and individualized intervention. Robust randomized data are still needed to define the optimal role of pMCS in AMI-related CS. Full article

(This article belongs to the Special Issue Acute Myocardial Infarction: Diagnosis, Treatment, and Rehabilitation)

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