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

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

Deadline for manuscript submissions: 17 May 2024 | Viewed by 5807

Special Issue Editors

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
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
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

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 100 words) can be sent to the Editorial Office for announcement on this website.

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-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly 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 2600 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

  • 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

Published Papers (4 papers)

Order results
Result details
Select all
Export citation of selected articles as:

Research

Jump to: Review

12 pages, 1577 KiB  
Article
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://0-doi-org.brum.beds.ac.uk/10.3390/jcm12062392 - 20 Mar 2023
Viewed by 2500
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 [...] Read more.
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
Show Figures

Figure 1

14 pages, 1851 KiB  
Article
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://0-doi-org.brum.beds.ac.uk/10.3390/jcm11247426 - 14 Dec 2022
Cited by 2 | Viewed by 915
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 [...] Read more.
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
Show Figures

Figure 1

16 pages, 2004 KiB  
Article
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://0-doi-org.brum.beds.ac.uk/10.3390/jcm11216252 - 23 Oct 2022
Viewed by 1255
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 [...] Read more.
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
Show Figures

Figure 1

Review

Jump to: Research

16 pages, 697 KiB  
Review
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://0-doi-org.brum.beds.ac.uk/10.3390/jcm13071885 - 25 Mar 2024
Viewed by 270
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) [...] Read more.
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
Show Figures

Figure 1

Back to TopTop