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Acute Cardiovascular Events: Broadening Perspectives in Acute Care

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A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: 15 July 2026 | Viewed by 6377

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Editors

Dr. Alexandra Arvanitaki

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Guest Editor

1. Second Department of Cardiology, Ippokrateio General Hospital, School of Medicine, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54642 Thessaloniki, Greece
2. Department of Emergency Medicine, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54642 Thessaloniki, Greece
3. Adult Congenital Heart Disease Unit, Royal Brompton Hospital, Guy’s and St Thomas’ Foundation Trust, Sydney Street, London SW3 5NP, UK
Interests: emergency medicine; cardiovascular imaging; cardiac disease and pregnancy; congenital heart disease; pulmonary hypertension
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Dr. Athina Nasoufidou

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Guest Editor Assistant

Second Department of Cardiology, Hippokration General Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642 Thessaloniki, Greece
Interests: emergency medicine; cardiovascular imaging; congenital heart disease; pediatric cardiology

Special Issue Information

Dear Colleagues,

Acute cardiovascular events continue to represent one of the leading causes of morbidity and mortality worldwide, placing a profound burden on patients, families, healthcare professionals, and healthcare systems. Beyond the immediate risk to life, these conditions frequently result in long-term complications, functional decline, diminished quality of life, and psychological distress for affected individuals. At the societal level, their impact extends to escalating healthcare expenditures, increased reliance on emergency and critical care services, and significant loss of productivity. Despite major advances in diagnostic strategies, interventional therapies, and preventive approaches, acute cardiovascular emergencies remain a pressing challenge across diverse clinical and health system contexts.

The spectrum of cardiovascular emergencies is broad and multifaceted, including acute coronary syndromes, life-threatening arrhythmias, sudden cardiac arrest, acute heart failure and cardiogenic shock, cerebrovascular events, hypertensive crises, pulmonary embolism, acute aortic syndromes, pericardial tamponade, pregnancy-related cardiovascular emergencies, and acute complications of valvular, structural, or congenital heart disease. Their heterogeneity, rapid progression, and frequent coexistence with comorbidities complicate timely diagnosis and compromise treatment strategies. While evidence-based, guideline-directed therapies are available, barriers related to health system preparedness, resource allocation, and inequities in access to care often limit translation into routine practice, particularly in low-resource or non-urban settings.

This Special Issue aims to stimulate discussion and disseminate new evidence on the management of acute cardiovascular emergencies. We invite contributions addressing clinical interventions, healthcare delivery, patient experiences, disparities in care, epidemiology, and innovative technologies that may shape the future of acute cardiovascular care and improve outcomes for patients and health systems alike.

Dr. Alexandra Arvanitaki
Guest Editor

Dr. Athina Nasoufidou
Guest Editor Assistant

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

acute cardiovascular events
emergency medicine
acute coronary syndromes
arrhythmias
cardiogenic shock
pregnancy-related cardiovascular emergencies
innovative technologies in acute care
patient-centered care

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Published Papers (6 papers)

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Research

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12 pages, 1162 KB

Open AccessArticle

Acute Coronary Occlusion in NSTEMI Patients: Prevalence, Clinical Characteristics and the Potential Role of Artificial Intelligence

by Christina Stathakopoulou, Charalampos Varlamos, Haroun Butt, Iosif Xenogiannis, Vassiliki-Maria Dragona, Despoina-Rafailia Benetou, Stefanos Vlachos, Christos Pappas, Fotios Kolokathis, Thomas R. Keeble and Grigoris V. Karamasis

Medicina 2026, 62(5), 899; https://doi.org/10.3390/medicina62050899 - 7 May 2026

Viewed by 545

Abstract

Background and Objectives: The electrocardiogram (ECG)–based STEMI/NSTEMI classification determines the urgency of invasive management in acute myocardial infarction. However, it often underestimates the presence of acute coronary occlusion (ACO) in patients presenting with non-ST-elevation myocardial infarction (NSTEMI). Artificial intelligence (AI)-assisted ECG interpretation has emerged as a potential tool to improve early recognition of ACO. This study aimed to determine the prevalence of ACO among NSTEMI patients, to compare clinical characteristics between patients with and without ACO and to explore the potential role of AI in earlier recognition of ACO. Materials and Methods: All consecutive NSTEMI patients undergoing coronary angiography between September 2022 and December 2024 were included. Contrary to other studies that included TIMI flow grades 0–1, 0–2, or 0–3, ACO in our study was defined strictly as a culprit lesion with TIMI flow grade 0 at index coronary angiography. Clinical characteristics were compared between ACO and non-ACO patients. Admission 12-lead ECGs from ACO patients were retrospectively analysed using a clinically validated AI-based ECG interpretation model and classified according to the urgency of invasive management. Results: Among 520 NSTEMI patients, 49 (9.4%) had angiographically confirmed ACO. Within the non-ACO group, 7.0% of patients had TIMI flow grade 1 on index coronary angiography (6.3% of the total population). Therefore, 15.7% of the study population had TIMI flow grade 0/1. ACO patients were younger (60.9 ± 12.8 vs. 66.3 ± 12.0 years, p = 0.0065). Clinical characteristics did not differ between the groups, except for dyslipidemia, which was more prevalent in non-ACO patients (38.8% vs. 53.9%, p = 0.043). Revascularisation rates were higher in the ACO group (93.9% vs. 82.2%, p = 0.037). Culprit vessel distribution differed markedly between the groups (p < 0.0001). In multivariable logistic regression analysis, age was independently associated with ACO (OR 0.96, 95% CI 0.93–0.99, p = 0.007). AI-assisted ECG analysis was performed in 42 ACO patients; 57.1% were classified as requiring immediate invasive management. Conclusions: A significant proportion of NSTEMI patients have ACO. AI-assisted ECG interpretation may support earlier identification of ACO, although its clinical impact requires further validation. Future studies are warranted to confirm these findings. Full article

(This article belongs to the Special Issue Acute Cardiovascular Events: Broadening Perspectives in Acute Care)

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13 pages, 1176 KB

Open AccessArticle

Use of the Hypoxia–Age–Shock Index at Triage to Predict Mortality in Geriatric STEMI Patients Undergoing Primary PCI

by Man-Ju Ting, Wan-Ju Chao, San-Fang Chou, Shyh-Shyong Sim, Chih-Jung Chang and Chien-Chieh Hsieh

Medicina 2026, 62(2), 365; https://doi.org/10.3390/medicina62020365 - 12 Feb 2026

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Abstract

Background and Objectives: Older adults with ST-segment elevation myocardial infarction (STEMI) experience disproportionately high mortality despite advances in reperfusion therapy. The Shock Index (SI) and Age–Shock Index (ASI) offer rapid hemodynamic assessment but do not address hypoxia. The Hypoxia–Age–Shock Index (HASI), which incorporates oxygen saturation (SpO₂), may improve early mortality prediction in geriatric STEMI. Materials and Methods: This retrospective cohort study included adult STEMI patients receiving primary percutaneous coronary intervention (PCI) at a tertiary center from 2019 to 2023. A total of 711 patients were analyzed, including 254 aged ≥65 years. SI, ASI, and HASI were calculated using triage vital signs prior to intervention. The primary outcome was in-hospital mortality. Thirty-day mortality was analyzed as a pre-specified secondary endpoint using Kaplan–Meier survival analysis and multivariable Cox regression. Discrimination was assessed using ROC curves with pairwise AUC comparison by DeLong’s test. Results: Elderly patients showed higher creatinine and troponin T levels, lower hemoglobin, and elevated ASI and HASI values (all p < 0.001). They had increased rates of cardiogenic shock (26.8% vs. 14.0%), major adverse events (26.0% vs. 10.1%), and in-hospital mortality (9.4% vs. 3.7%, p = 0.003). Age ≥ 65 years independently predicted 30-day mortality (adjusted HR 2.59, 95% CI 1.34–5.04). Among indices, HASI demonstrated the highest discriminative performance (AUC 0.703 in elderly; 0.743 in younger patients). Conclusions: In geriatric STEMI, HASI demonstrated numerically higher discriminative performance for in-hospital mortality compared with SI and ASI, supporting its use as a simple and rapid triage tool. Full article

(This article belongs to the Special Issue Acute Cardiovascular Events: Broadening Perspectives in Acute Care)

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12 pages, 545 KB

Open AccessArticle

The Monday Effect: Weekly and Circadian Patterns in Acute Cardiovascular Emergencies Monday Effect in Cardiovascular Emergencies

by Gamze Yeter Arslan and Erkan Baysal

Medicina 2026, 62(1), 160; https://doi.org/10.3390/medicina62010160 - 13 Jan 2026

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Abstract

Background and Objectives: Monday syndrome refers to a psychosomatic stress response occurring at the beginning of the work week and has been implicated in triggering acute cardiovascular events. This study aimed to evaluate the association between Monday syndrome and the incidence of cardiovascular emergencies. Materials and Methods: Between June 2024 and June 2025, a total of 500 patients aged 18–65 years who presented with acute cardiovascular events at two centers were retrospectively analyzed. Diagnoses included STEMI, NSTEMI, unstable angina, ventricular tachycardia/fibrillation, and hypertensive emergency. The distribution of events by weekday and hour was examined. Poisson regression was used to assess the effect of Mondays on event incidence. Results: Of 500 patients (mean age 49.1 ± 9.7 years, 50.4% male), the most common diagnoses were STEMI (31.8%) and NSTEMI (27.4%). The incidence of cardiovascular events was highest on Mondays (19.6%) and lowest on Sundays (10.6%). The early-morning period (06:00–10:00) showed the most significant clustering of events (p < 0.001). Systolic blood pressure (145 ± 18 vs. 139 ± 17 mmHg, p = 0.008) and heart rate (87 ± 12 vs. 82 ± 13 bpm, p = 0.01) were significantly higher on Mondays. Monday presentation was associated with a 23% higher event rate (incidence rate ratio [IRR] 1.23, 95% CI 1.10–1.38, p = 0.002). Conclusions: Monday syndrome is associated with a significant increase in the incidence of cardiovascular emergencies, especially in the early-morning hours. Increased sympathetic tone, hormonal activation, and psychosocial stress are possible contributors. Full article

(This article belongs to the Special Issue Acute Cardiovascular Events: Broadening Perspectives in Acute Care)

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15 pages, 2443 KB

Open AccessArticle

Female Disparity in Referral to Cardiac Diagnostication and Invasive Treatment

by Rajesh Bhavsar, Leif Thuesen and Carl-Johan Jakobsen

Medicina 2026, 62(1), 144; https://doi.org/10.3390/medicina62010144 - 10 Jan 2026

Cited by 1 | Viewed by 768 | Correction

Abstract

Background and Objectives: Despite huge reductions in the incidence and mortality of cardiovascular disease (CVD) during the last decades, ischemic heart disease (IHD) is globally still a leading cause of death. Although females experience higher mortality, the clinical IHD guidelines do not distinguish between sexes, and despite added diagnostic procedures after introduction of computed coronary arteriography (CTA) the differences remain. This study aimed to describe and evaluate the effect, outcomes and sex disparities of the large number of diagnostic procedures not leading to invasive treatments. Materials and Methods: The study included 274,617 first-entry patients submitted to invasive coronary arteriography (ICA) or CTA 2000–2020, from the mandatory Western Denmark Heart Registry. Mortality was evaluated with Kaplan–Meier curves and further compared to background population. Results: Females constituted 34.1% of all first-entry diagnostic procedures but only 25.5% of those who subsequently underwent invasive treatment, demonstrating a substantially lower treatment rate compared to males. All-cause 10-year mortality was higher in females after treatment 1.26 (1.23–1.30) but lower in the non-treated patients 0.71 (0.67–0.72) at all time points. Comparing to the background population, all non-treated patients revealed lower mortality in all indications, except valves. Conclusions: Despite being referred for coronary diagnostication according to their CVD prevalence, females received less invasive treatments than males and presented with substantially higher mortality after invasive treatments. In variance, non-invasive treated females demonstrated significantly better survival than men both in intra-study comparisons and in assessment with background population mortality. Full article

(This article belongs to the Special Issue Acute Cardiovascular Events: Broadening Perspectives in Acute Care)

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21 pages, 2068 KB

Open AccessReview

Maternal Cardiovascular Emergencies During Pregnancy and the Puerperium: Current Diagnostic Approach and Management

by Alexandra Arvanitaki, Christos Kalimanis, Athina Nasoufidou, Marios G. Bantidos, Efstratios Karagiannidis, Michail Kalinderis, Nikolaos Fragakis, Barbara Fyntanidou and Ioannis Tsakiridis

Medicina 2026, 62(2), 401; https://doi.org/10.3390/medicina62020401 - 19 Feb 2026

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Abstract

Physiologic changes during pregnancy, advanced maternal age, and cardiovascular comorbidities have been associated with an increased incidence of cardiovascular emergencies (CVEs) manifesting during pregnancy and puerperium, thereby adversely affecting maternal and fetal morbidity and mortality. When a CVE occurs, prompt and high-quality medical management is essential. However, the early diagnosis and management of CVEs in pregnant women are often challenging, as the initial clinical presentation of many of these conditions may mimic common symptoms of a normal pregnancy, resulting in significant diagnostic delays. Furthermore, the administration of optimal medical or interventional therapy in critically ill pregnant women should be carefully considered, balancing maternal well-being and survival against the potential risks that certain medications and interventions may pose to the fetus. Consequently, treatment decisions should involve a multidisciplinary medical team, comprising cardiologists, obstetricians, emergency physicians, anesthesiologists, neonatologists, and other relevant specialists. This review aims to summarize the current diagnostic approaches and management strategies for the most prevalent CVEs encountered during pregnancy, and explore the challenges faced in diagnosing and treating pregnant individuals compared to the non-pregnant population, emphasizing the differences and knowledge gaps in this area. Full article

(This article belongs to the Special Issue Acute Cardiovascular Events: Broadening Perspectives in Acute Care)

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