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Clinical Diagnosis and Therapeutic Approaches for Acute and Chronic Coronary Syndromes

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

Deadline for manuscript submissions: 20 March 2026 | Viewed by 2456

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Guest Editor
Dipartimento di Scienze Cardiovascolari—CUORE, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
Interests: acute coronary syndrome; coronary microvascular dysfunction
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Special Issue Information

Dear Colleagues,

Coronary artery disease (CAD) remains a significant health concern globally, characterized by the narrowing or blockage of coronary arteries due to atherosclerosis. However, up to half of patients undergoing coronary angiography for suspected myocardial ischemia and about 8% of patients with myocardial infarction have unobstructed coronary arteries. Thus, management of patients with myocardial ischemia or myocardial infarction is complex and involves a comprehensive assessment of risk factors, symptoms, and invasive and non-invasive diagnostic tests. Treatment strategies aim to alleviate symptoms, prevent complications, and improve overall prognosis. Interventions may include lifestyle modifications, pharmacotherapy, percutaneous coronary intervention, or coronary artery bypass grafting, tailored to individual patient needs. Multidisciplinary collaboration among cardiologists, cardiac surgeons, and other healthcare professionals is crucial. Advances in research continue to enhance our understanding of pathophysiology, both in patients presenting with acute coronary syndrome (ACS) or chronic coronary syndrome (CCS), and refine treatment approaches, emphasizing personalized medicine and precision interventions.

Prof. Dr. Rocco Antonio Montone
Guest Editor

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Keywords

  • coronary artery disease
  • clinical diagnosis
  • therapeutic approaches
  • atherosclerosis
  • risk factors
  • percutaneous cor-onary intervention
  • acute coronary syndrome
  • MINOCA
  • INOCA

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Published Papers (2 papers)

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Review

23 pages, 5095 KB  
Review
Prognostic Role and Therapeutic Implications of Intravascular Optical Coherence Tomography Detected Coronary Plaque Microstructures in Patients with Coronary Artery Disease
by Michele Russo, Elena Bacigalupi, Francesco Radico, Luca Scorpiglione, Filippo Luca Gurgoglione, Alessandro Russo, Carlo Vigna, Mattia Galli, Stefano Benenati, Rocco Vergallo, Rocco Antonio Montone, Umberto Benedetto, Giampaolo Niccoli, Francesco Prati and Marco Zimarino
J. Clin. Med. 2025, 14(22), 8132; https://doi.org/10.3390/jcm14228132 - 17 Nov 2025
Viewed by 739
Abstract
Intracoronary optical coherence tomography (OCT) is a highly accurate and sensitive imaging tool capable of providing high resolution visualization of atherosclerotic coronary plaque morphology and microstructures in vivo. OCT has proven to be useful in clinical practice, particularly in percutaneous coronary intervention (PCI) [...] Read more.
Intracoronary optical coherence tomography (OCT) is a highly accurate and sensitive imaging tool capable of providing high resolution visualization of atherosclerotic coronary plaque morphology and microstructures in vivo. OCT has proven to be useful in clinical practice, particularly in percutaneous coronary intervention (PCI) guidance, assessment of stent-related complications, and elucidation of the pathobiological cause of acute coronary syndrome. Notably, OCT allows for the detection of specific plaque features (i.e., thin cap fibroatheroma, lipid-rich plaque, macrophage infiltration, healed plaques, microvessels, etc.) that are known to carry prognostic significance in the context of coronary artery disease (CAD). These insights may offer valuable information about the patient’s overall atherosclerotic background, potentially supporting more personalized secondary prevention strategies, including lifestyle modification and targeted pharmacologic therapies. Recently, the role of preventive PCI in plaques with high-risk features has also been investigated with promising—though still preliminary—results. In this narrative review, we primarily aim to discuss studies evaluating the prognostic value of OCT-identified coronary plaque microstructures. We also assessed potential therapeutic implications in the management of patients with CAD. Full article
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15 pages, 697 KB  
Review
Ischemia with Non-Obstructive Coronary Artery Disease: Sex-Based Differences in Pathophysiology, Clinical Presentation, and Prognosis
by Filippo Luca Gurgoglione, Giorgio Benatti, Andrea Denegri, Emilia Solinas, Iacopo Tadonio, Mattia De Gregorio, Laura Torlai Triglia, Davide Donelli, Marco Covani, Gabriella Dallaglio, Federico Barocelli, Giulia Magnani, Michele Russo, Luigi Vignali and Giampaolo Niccoli
J. Clin. Med. 2025, 14(16), 5764; https://doi.org/10.3390/jcm14165764 - 14 Aug 2025
Cited by 1 | Viewed by 1393
Abstract
Ischemia with non-obstructive coronary arteries (INOCA) is a chronic coronary condition associated with poor prognosis and reduced quality of life. The increasing use of invasive assessments of microcirculatory function and provocative spasm testing has significantly advanced the understanding of INOCA’s pathophysiology, which ranges [...] Read more.
Ischemia with non-obstructive coronary arteries (INOCA) is a chronic coronary condition associated with poor prognosis and reduced quality of life. The increasing use of invasive assessments of microcirculatory function and provocative spasm testing has significantly advanced the understanding of INOCA’s pathophysiology, which ranges from coronary microvascular dysfunction to vasomotor disorders. However, the optimal management and therapeutic approach for INOCA remain to be determined. Significant sex-based differences in the pathophysiology of INOCA have been reported, resulting in variations in prevalence, phenotype, and natural history between male and female patients. The aim of this narrative review is to provide a comprehensive overview of the sex-specific pathophysiological mechanisms underlying INOCA and to summarize the differences in INOCA phenotype and prognosis. Additionally, we will explore the current knowledge on management and therapy, with the goal of advancing towards sex-based personalized treatment strategies for INOCA. Full article
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