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Acute Coronary Syndrome: Recent Advances in Clinical Diagnosis and Treatment

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

Deadline for manuscript submissions: closed (30 October 2024) | Viewed by 6556

Special Issue Editors


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Guest Editor
Cardiology Department, Hospital Universitario de Navarra, 31006 Pamplona, Spain
Interests: eHealth; heart failure; acute coronary syndrome; frailty; comorbidity; revascularization

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Guest Editor
Cardiology Service, Hospital Universitario La Princesa, 28006 Madrid, Spain
Interests: chronic heart failure; acute heart failure; acute coronary syndromes; atrial fibrillation; elderly

Special Issue Information

Dear Colleagues,

In recent years, we have seen significant advances in understanding and managing acute coronary syndrome, a condition that continues to be a major challenge in medical practice worldwide. This Special Issue aims to bring together experts and scientists from different countries to discover and share the latest developments in the diagnosis and treatment of acute coronary syndrome, as well as analyze their impact on clinical outcomes and quality of life for patients.

Technological advancements and innovative treatment modalities, pharmacological therapies and interventional procedures provide us with new insights and approaches to the treatment of this complex disease. We encourage you to submit your contributions in the form of review articles, original research and clinical studies that address key aspects of acute coronary syndrome and its clinical implications. This is a unique opportunity to spread knowledge, foster international dialogue and advance the fight against a disease that affects millions of people around the world. We look forward to your valuable participation in this Special Issue that is sure to enrich the field and help improve patient care. 

Dr. Gonzalo Luis Alonso Salinas
Dr. Pablo Díez-Villanueva
Guest Editors

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Keywords

  • acute coronary syndrome
  • cardiogenic shock
  • electrocardiogram
  • eHealth
  • percutaneous coronary intervention
  • coronary bypass surgery
  • revascularization
  • diagnostics
  • myocardial injury
  • antithrombotic therapy

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Published Papers (5 papers)

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Research

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13 pages, 1442 KiB  
Article
OMI/NOMI: Time for a New Classification of Acute Myocardial Infarction
by Martiola Kola, Naltin Shuka, Harvey Pendell Meyers, Elizana Zaimi (Petrela) and Stephen W. Smith
J. Clin. Med. 2024, 13(17), 5201; https://doi.org/10.3390/jcm13175201 - 2 Sep 2024
Viewed by 2202
Abstract
Forty percent of patients with acute coronary occlusion myocardial infarction (OMI) do not present with STEMI criteria, which delays their treatment and increases morbidity and mortality. The need to identify these patients promptly is crucial, and this sets the stage for the proposed [...] Read more.
Forty percent of patients with acute coronary occlusion myocardial infarction (OMI) do not present with STEMI criteria, which delays their treatment and increases morbidity and mortality. The need to identify these patients promptly is crucial, and this sets the stage for the proposed reclassification. Many of these patients can be identified by other ECG and clinical features. Background/Objectives: We sought to evaluate cases of STEMI and NSTEMI that result in OMI. Additionally, we focused on the consequences of delayed revascularization in NSTEMI patients with acute coronary occlusion (NSTEMI-OMI). Methods: The study is a retrospective analysis conducted on 334 patients who underwent coronary angiography for acute coronary syndrome at UHC “Mother Teresa”, Tirana, Albania, during January–May 2023. “OMI was defined as an acute culprit lesion with TIMI 0–2 flow, or an acute culprit lesion with TIMI 3 flow intervened upon and with highly elevated troponin (cTnI > 10.0 ng/mL, hs-cTnI > 5000 ng/L)”. The presence or absence of STEMI criteria were determined in the final diagnosis written on the chart by a cardiologist using the third universal definition of MI. Ejection fraction (EF), total ischemia time, length of stay, and complications were compared between groups. Mechanical complications include acute ventricular failure, cardiogenic shock, rupture of the interventricular septum, rupture of the free wall, rupture of the papillary muscle, and pericarditis. Electrical complications include ventricular arrhythmias, supraventricular arrhythmias, and atrioventricular and interventricular blocks. Results: There were 334 patients included, 98 (29.3%) of whom were NSTEMI-OMI patients. Ninety-six patients (40%) of OMI patients did not fulfill the STEMI criteria. Only 11 patients (11%) of STEMI(−)OMI had PCI performed within the first 12 h vs. 76 patients (77%) with STEMI(+)OMI, p < 0.001. There was no difference in the percent of patients requiring PCI between the STEMI(+)OMI 98 patients (93%) and STEMI(−)OMI 87 patients (89%) (p = 0.496). The overall in-hospital mortality was 19 patients (5.7%), with subgroup mortality of 14 patients (4.2%) with STEMI(+)OMI, 2 patients (0.6%) with STEMI(+) NOMI, and 3 patients (0.9%) with STEMI(−)OMI, 0% STEMI(−)NOMI, (p = 0.013). Patients with mechanical complications included 67 patients (46.8%) with STEMI(+)OMI and 45 patients (46.4%) with STEMI(−)OMI. In addition, 26 patients (18.5%) with STEMI(+)OMI and 13 patients (13.1%) with STEMI(−)OMI developed electrical complications. Conclusions: STEMI(−)OMI patients had significant delays in catheterization, yet had angiographic findings, rates of PCI, and complications similar to STEMI(+)OMI. These data add further support to refocusing the paradigm of acute MI to improve recognition and rapid reperfusion of all OMIs, rather than only those with STEMI criteria. Full article
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8 pages, 213 KiB  
Article
Safety of an Early Discharge Strategy (≤48 h) after ST-Elevation Myocardial Infarction
by Antonio Piris, Luis Manuel Garcia-Linacero, Rodrigo Ortega-Perez, Sonia Rivas-Garcia, Rafael Martinez-Moya, Marcelo Sanmartin and Jose Luis Zamorano
J. Clin. Med. 2024, 13(13), 3827; https://doi.org/10.3390/jcm13133827 - 29 Jun 2024
Viewed by 706
Abstract
Background: Early discharge following ST-segment-elevation myocardial infarction (STEMI) confers notable advantages for both patients and healthcare systems. However, the adoption of a very early discharge strategy for selected patients remains limited due to safety considerations. We aimed to provide some insight into [...] Read more.
Background: Early discharge following ST-segment-elevation myocardial infarction (STEMI) confers notable advantages for both patients and healthcare systems. However, the adoption of a very early discharge strategy for selected patients remains limited due to safety considerations. We aimed to provide some insight into the safety of a discharge program with a hospital stay lasting <48 h after a primary percutaneous coronary intervention (PCI). Methods: Using a registry of 1105 patients undergoing primary PCI for STEMI in our hospital between January 2015 and October 2023, we enrolled all the patients who had a hospital stay ≤48 h, according to a prespecified institutional protocol. The primary objective was a combined rate of non-fatal stroke, non-fatal acute myocardial infarction, or cardiovascular death within 30 days of discharge. Emergency department visits or hospitalizations due to cardiovascular causes, along with the all-cause mortality, were measured during the same period. Results: A total of 453 (41%) patients were discharged ≤48 h after admission for a STEMI. The mean age was 62.4 (±12.5 years), 24.3% were women, and 17.9% were people with diabetes. Up to 96% of the procedures had been performed through radial artery access, and there were no major vascular complications. Regarding the primary endpoint, there was one event (0.2%; one patient suffered a non-fatal myocardial infarction). There were no cardiovascular deaths or deaths from other causes. Only five patients (1.1%) were re-hospitalized or visited the emergency department due to cardiovascular causes. Conclusions: An early discharge strategy for patients within 48 h of experiencing STEMI and undergoing primary PCI appears feasible and safe. Full article
12 pages, 844 KiB  
Article
The Evaluation of Lipid-Lowering Treatment in Patients with Acute Coronary Syndrome in a Hungarian Invasive Centre in 2015, 2017, and during the COVID-19 Pandemic—The Comparison of the Achieved LDL-Cholesterol Values Calculated with Friedewald and Martin–Hopkins Methods
by Laszlo Mark, Péter Fülöp, Hajnalka Lőrincz, Győző Dani, Krisztina Fazekas Tajtiné, Attila Thury and György Paragh
J. Clin. Med. 2024, 13(12), 3398; https://doi.org/10.3390/jcm13123398 - 11 Jun 2024
Cited by 2 | Viewed by 901
Abstract
Background/Objectives: Patients with acute coronary syndrome (ACS) represent a vulnerable population. We aimed to investigate serum lipid levels of patients with ACS upon admission and during one year of the COVID-19 pandemic in a rural county hospital, and compared these findings with the [...] Read more.
Background/Objectives: Patients with acute coronary syndrome (ACS) represent a vulnerable population. We aimed to investigate serum lipid levels of patients with ACS upon admission and during one year of the COVID-19 pandemic in a rural county hospital, and compared these findings with the data of patients with ACS in 2015 and 2017. The secondary aim of this paper was the comparison of the LDL-C values calculated with the Friedewald and Martin–Hopkins methods. Methods: A retrospective analysis of lipid-lowering data of patients treated with ACS in 2015, 2017 and in a COVID-19 year (1 April 2020–31 March 2021) was performed; the patient’s numbers were 454, 513 and 531, respectively. Results: In the COVID-19 period one year after the index event, only 42% of the patients had lipid values available, while these ratios were 54% and 73% in 2017 and in 2015, respectively. Using the Friedewald formula, in the COVID-19 era the median of LDL cholesterol (LDL-F) was 1.64 (1.09–2.30) mmol/L at six months and 1.60 (1.19–2.27) mmol/L at one year, respectively. These values were 1.92 (1.33–2.27) mmol/L and 1.73 (1.36–2.43) mmol/L using the Martin–Hopkins method (LDL-MH). The LDL-F yielded significantly lower values (15% lower at six months, p = 0.044; and 8% lower at one year, p = 0.014). The LDL-F reached the previous target of 1.8 mmol/L during the COVID-19 pandemic 36% at one year vs. 48% in 2017, and 37% in 2015. The recent target LDL-C level of 1.4 mmol/L was achieved in 22% of cases in the COVID-19 pandemic, 16% in 2015 and 19% in 2017. Conclusions: A significantly lower proportion of patients with ACS had available lipid tests during the COVID-19 pandemic. Besides the lower number of available samples, the proportion of achieved 1.4 mmol/L LDL-C target lipids was stable. More rigorous outpatient care in the follow-up period may help to improve the quality of lipid lowering treatments and subsequent secondary cardiovascular prevention. If direct LDL-C determination is not available, we prefer the LDL calculation with the Martin–Hopkins method. Full article
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8 pages, 446 KiB  
Article
Parenteral Anticoagulation at First Medical Contact Improves Infarct Related Artery Patency in STEMI
by Vlad Bataila, Nicoleta-Monica Popa-Fotea, Cosmin Cojocaru, Lucian Calmac, Cosmin Mihai, Marian-Bogdan Dragoescu, Vlad Ploscaru, Mugur Marinescu, Vasile Iliese, Anamaria-Georgiana Avram, Raluca-Elena Mitran and Radu-Gabriel Vatasescu
J. Clin. Med. 2024, 13(6), 1710; https://doi.org/10.3390/jcm13061710 - 16 Mar 2024
Cited by 1 | Viewed by 1009
Abstract
(1) Background: Acute ST-segment elevation myocardial infarction (STEMI) remains one of the main morbidity and mortality contributors worldwide. Its main treatment, primary percutaneous coronary intervention (pPCI), can only be performed with a high anticoagulation regimen, usually with heparin. There is still not [...] Read more.
(1) Background: Acute ST-segment elevation myocardial infarction (STEMI) remains one of the main morbidity and mortality contributors worldwide. Its main treatment, primary percutaneous coronary intervention (pPCI), can only be performed with a high anticoagulation regimen, usually with heparin. There is still not enough evidence regarding the timing of heparin administration. (2) Methods: We conducted a multicenter observational study of 614 consecutive STEMI patients treated between 2017 and 2019. We split the population in two groups: one that received heparin at the first medical contact, as early as possible, and the second group that received heparin at the PCI capable center or in the cath lab. (3) Results: There was a significantly higher rate of infarct-related artery (IRA) patency at the time of the coronary angiogram in the pre-transfer heparin group than in the on-site heparin group, 44.7% vs. 37.3%, p = 0.042. Also, the early heparin group received shorter and wider stents. There was no difference in bleeding rates or in the in-hospital and two-year mortality rates. (4) Conclusions: Early administration of heparin leads to a higher rate of reperfusion in the IRA, before pPCI, with significant related benefits, such as better stent implantation parameters, without increased bleeding rates. Full article
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8 pages, 216 KiB  
Study Protocol
Accuracy of Smartwatch Electrocardiographic Recording in the Acute Coronary Syndrome Setting: Rationale and Design of the ACS WATCH II Study
by Mauro Buelga Suárez, Marina Pascual Izco, Jesús García Montalvo and Gonzalo Luis Alonso Salinas
J. Clin. Med. 2024, 13(2), 389; https://doi.org/10.3390/jcm13020389 - 10 Jan 2024
Viewed by 1213
Abstract
Background: Acute Coronary Syndrome (ACS), with or without ST-segment elevation, is a major contributor to global mortality and morbidity. Swift diagnosis and treatment are vital for mitigating cardiac damage and improving long-term outcomes. The 12-lead electrocardiogram (ECG) currently serves as the gold [...] Read more.
Background: Acute Coronary Syndrome (ACS), with or without ST-segment elevation, is a major contributor to global mortality and morbidity. Swift diagnosis and treatment are vital for mitigating cardiac damage and improving long-term outcomes. The 12-lead electrocardiogram (ECG) currently serves as the gold standard for diagnosis in ACS with ST-segment elevation and may support the diagnosis in ACS without ST-segment elevation. However, the growing prevalence of smartwatches enables the acquisition of electrocardiographic data without traditional ECG equipment. While smaller studies support smartwatch ECG use, larger-scale validation within ACS remains lacking. The ACS WATCH II study aims to validate smartwatch ECG recordings for ACS. Methods: The primary objective is to validate smartwatch-obtained electrocardiographic data in patients presenting with ACS. Two cohorts of 120 patients each, presenting ACS with and without ST-segment elevation, will be assessed. Smartwatches will capture recordings of leads I, III, and V2 alongside standard ECGs. These leads, chosen due to a 97% ACS diagnosis sensitivity in previous studies, will undergo blind evaluation by two experienced external assessors against conventional ECG. Additionally, a control sample of 60 healthy individuals will be included. Conclusions: ACS WATCH II pioneers large-scale prospective validation of smartwatch ECG recordings in ACS patients. Additionally, it indirectly validates a swift diagnostic approach using three leads (I, III, and V2). This could expedite time-critical ACS diagnoses and simplify access through smartwatch-based diagnosis. Full article
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