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Open research questions in Acute Myocardial Infarction Research

89 unresolved questions extracted from the limitations and future-work sections of 750 Acute Myocardial Infarction Research papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • High-sensitive cardiac troponin I (hs-cTnI) is a recognized marker of myocardial injury in acute coronary syndromes, but its utility in chronic coronary syndromes (CCS) remains unclear.

    The Value of Cardiac Troponin I and Midkine in predicting coronary artery obstruction severity in Chronic Coronary Syndromes (CCS) · 2026 · DOI

  • BackgroundThe optimal timing of percutaneous coronary intervention (PCI) in patients undergoing transcatheter aortic valve replacement (TAVR) remains unclear, particularly regarding its impact on renal outcomes.

    Renal Outcomes of Staged Versus Concomitant Percutaneous Coronary Intervention and Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis · 2026 · DOI

  • Notably, Ph1 showed discrepant significance between the primary independent imputed and complete-case analyses, and prognostic value therefore remains uncertain pending prospective validation in larger cohorts with systematic HbA1c ascertainment.

    Unsupervised cardiometabolic phenotyping unmasks residual MACCE risk beyond LDL-C in acute myocardial infarction after revascularization · 2026 · DOI

  • Future research should move from risk description toward testing structured responses to troponin elevation outside type 1 myocardial infarction. Prospective studies are needed to determine whether phenotype-based pathways improve outcomes after ACS has been excluded. Such pathways could evaluate whether selected patients benefit from repeat troponin testing, echocardiography, natriuretic peptide measurement, coronary risk assessment, rhythm monitoring, renal evaluation, heart failure optimization, or early post-discharge review. Trials should also clarify which troponin patterns carry actionable risk, including persistent elevation, rising or falling injury patterns, and subthreshold high-sensitivity troponin concentrations [15- 18]. The next step is not simply to detect more myocardial injury, but to determine which troponin-positive patients benefit from structured cardiovascular reassessment and targeted follow-up [5,20].

    Cardiac Troponin Elevation Beyond Type 1 Myocardial Infarction: A Systematic Review of Prognostic Significance and Cardiovascular Risk Stratification · 2026 · DOI

  • The fibrinogen-to-albumin ratio (FAR) is an inflammatory biomarker with prognostic value in cardiovascular disease, but its role in predicting LVA remains unclear.

    Fibrinogen-to-albumin ratio independently predicts left ventricular aneurysm in STEMI patients: a retrospective cohort study · 2026 · DOI

  • Future prospective, multi-center, large-scale cohort studies that incor- porate serial dynamic biomarkers and detailed procedural and treat- ment data are warranted to validate, refine, and enhance the clinical applicability of this prediction model. Future prospective, multi- center, large-scale cohort studies that incorporate serial dynamic biomarkers, detailed procedural and treatment data, and independent external validation are warranted to validate, refine, and enhance the clinical applicability of this prediction model.

    Analysis of risk factors for heart failure in patients with type 2 diabetes mellitus and acute ST-segment elevation myocardial infarction after percutaneous coronary intervention · 2026 · DOI

  • Background: Percutaneous coronary intervention (PCI) during extracorporeal cardiopulmonary resuscitation (ECPR) before sustained return of spontaneous circulation (ROSC) is increasingly performed, yet most published reports fail to document ROSC status at the time of intervention—leaving this specific clinical phenotype poorly characterized.

    Percutaneous Coronary Intervention Without Sustained Return of Spontaneous Circulation Under Extracorporeal Cardiopulmonary Resuscitation: A Phenotype-Oriented Descriptive Systematic Review · 2026 · DOI

  • Several key limitations must be considered when interpreting the findings. First, the retrospective, non-randomized design introduces significant selection bias and confounding by indication. Patients who received IABP were not randomly assigned but rather selected based on clinical judgment, institutional protocols, and perceived severity of shock. While statistical adjustments (e.g., multivariable regression and AIPW analysis) were applied, unmeasured confounders—such as variations in revascularization timing, adjunctive medical therapies, shock severity, or center-specific expertise—may still influence outcomes.

    Timing of IABP initiation and its impact on outcomes in acute myocardial infarction with cardiogenic shock: insights from a bi-center retrospective study · 2026 · DOI

  • individuals—particularly those with anterior STEMI or apical akinesis (O’Gara et al., 2013). However, Shavadia et al. demonstrated that in anterior STEMI patients with LVT, prophylactic vitamin K antagonist (VKA) use failed to reduce ischemic events but was associated with significantly higher bleeding complications (Shavadia et al., 2017). Mirroring this evidence, our patient developed LVT despite prophylactic enoxaparin after PCI. The choice of anticoagulant for LVT must balance efficacy, safety, and individual patient characteristics. Historically, VKAs have been the cornerstone of LVT management, supported by extensive clinical experience and guidelines (Byrne et al., 2023; Kleindorfer et al., 2021; O’Gara et al., 2013). In recent years, DOAC use in LVT has increased substantially, and the 2022 AHA scientific statement endorsed DOACs as a reasonable alternative for appropriately selected patients (Levine et al., 2022). Multiple observational meta-analyses have shown comparable efficacy and safety to VKAs (Alcalai et al., 2022; Dalia et al., 2021; Youssef et al., 2023). Notably, the RIVAWAR trial—the largest randomized controlled trial to date—found no significant differences between rivaroxaban and warfarin in thrombus resolution, mortality, or bleeding at 3 months (Shah et al., 2025). From a pharmacological perspective, rivaroxaban provides rapid, predictable factor Xa inhibition (peak 1.5–2.0 h, half-life 5–9 h) (Mueck et al., 2014), making it ideal for acute post-stroke anticoagulation. This supported our initial choice of rivaroxaban. However, rivaroxaban does not affect preformed thrombin nor reduce circulating prothrombin (factor II) levels. In contrast, Warfarin exerts broader suppression of the coagulation cascade by inhibiting vitamin K-dependent synthesis of multiple factors (II, VII, IX, X). This leads to a gradual, time-dependent depletion of these factors, with prothrombin (factor II) having the longest half-life (~60 h) (Lal et al., 2006). Such depletion may be particularly advantageous for established, fibrin-rich thrombi, as it directly reduces the substrate for new fibrin formation (Chen et al., 2018). Mechanistically, this difference could provide a theoretical rationale for switching to warfarin when early thrombus response to a single-target Xa inhibitor is suboptimal. However, in the absence of direct (e.g., by CMR or thrombus remains hypothesisinterpretation histopathology), generating and speculative, warranting validation in future studies with dedicated imaging.

    From heart to brain: a Case Report of individualized antithrombotic management for left ventricular thrombus and stroke in a young patient with acute myocardial infarction · 2026 · DOI

  • Because of the nature and context of the preventive heart health program, the use of an ITS approach is the most appropriate to estimate effects of behavioral change strategy as randomization is not feasible. This approach can provide valuable insights into the effectiveness of the program by assessing the changes over time and is more sensitive to differences in intervention effects, as it involves self-comparison of the participants, which controls for confounding variables to the greatest extent possible.

    Evaluating a Preventive Heart Health Program for Women at Midlife: Protocol for a Mixed Methods Pilot Study · 2026 · DOI

  • The intended result of this study is to evaluate the effective- ness and feasibility of a preventive heart health program among midlife women. By recognizing barriers and facil- itators associated with the sustainability of a preventive heart health program in midlife women, identifying microle- vel, mesolevel, and macrolevel factors associated with the provision of such a program, and enhancing understanding of health care provider and patient perceptions of preventive heart health care in women, this study will enable us to further refine the process and framework of sex-specific, tailored CVD prevention care, thereby enabling the upscal- ing of such services to other hospitals and improving future preventive care for midlife women. The research team would like to thank Professor Robyn Mildon of the Centre for Evidence and Implementation for her guidance and assistance. No generative artificial intelligence was used in any portion of the manuscript generation.

    Evaluating a Preventive Heart Health Program for Women at Midlife: Protocol for a Mixed Methods Pilot Study · 2026 · DOI

  • and validation standardized strategies in Regarding evidence for CR, randomized trials such as COMPLETE have established the benefit of a CR strategy in appropriate STEMI patients with multivessel disease by reducing ischemia-driven adverse outcomes. Subsequent trials have further explored the timing of CR (index procedure vs. staged), primarily addressing “whether” and “when” to perform CR from a strategy and prognosis perspective (4, 36). However, these studies do not directly address a pragmatic question in real-world practice: whether procedural (same-session) CR can be achieved during the index PCI, which is highly relevant to workflow management and resource planning in the catheterization laboratory. Accordingly, by modeling the likelihood of achieving CR during the index PCI as an independent prediction task—alongside (in-hospital) HF prediction—our work extends the existing literature by providing evidence oriented toward procedural feasibility assessment and cath-lab decision support. 4.4 Clinical implications circulatory support—potentially surveillance of volume status and hemodynamics, timely initiation or escalation of diuretics and/or inotropic support, and, when appropriate, early consideration of indications for enabling mechanical (37). intervention before overt Conversely, for patients predicted to be at low risk, the model may facilitate more efficient allocation of monitoring resources while maintaining patient safety. Importantly, this tool is intended to support risk stratification and clinical decision-making rather than replace physician judgment, and its outputs should be in conjunction with dynamic clinical course, imaging, and laboratory findings (38). clinical deterioration interpreted 4.4.2 Potential clinical applications of the CR feasibility prediction model Unlike traditional studies that primarily address whether CR is beneficial or when staged revascularization is preferable, our CR model focuses on a pragmatic, workflow-oriented question in real-world practice: whether same-session CR is likely to be feasible during the index PCI. In the catheterization laboratory, this prediction may support procedural planning and early intra-procedural decision-making. For example, when the model indicates a high likelihood of achieving procedural CR, operators may more proactively evaluate and treat non-culprit lesions while maintaining procedural safety.

    Multicenter development and validation of machine-learning risk models to predict procedural complete revascularization and in-hospital heart failure in STEMI patients treated with primary PCI · 2026 · DOI

  • BACKGROUND: Whether a conservative strategy of medical therapy alone or a strategy of medical therapy plus invasive treatment is more beneficial in older adults with non-ST-segment elevation myocardial infarction (NSTEMI) remains unclear.

    Invasive Treatment Strategy for Older Patients with Myocardial Infarction · 2024 · DOI

  • We noticed that percutaneous coronary intervention within 12 hours of onset is an excellent treatment for ST-elevated myocardial infarction patients, and it is more beneficial to perform percutaneous coronary intervention as soon as possible. Recovery of blood flow to the myocardium could recover the dysfunction of the left ventricle. Our findings are consistent with multiple study results that highlighted the recovery of left ventricle dysfunction after percutaneous coronary intervention in ST-elevated myocardial infarction presented within 12 hours of the onset of chest pain (20,22,23). Moreover, study results suggested that considering the male-to- female ratio, males have a triple higher chance of ST-elevated myocardial infarction than females, with the highest relative risk below the age of 55 years (6). We found that the percentage of ST-elevated myocardial infarction cases in males (74.4%) was higher than in females (21.6%), and the findings are The sample size of our study was relatively small, and a study on a larger sample sizes needs to be conducted to validate the results of this study.

    Case Series Study on Recovery of Left Ventricle Systolic Function After Percutaneous Coronary Intervention In ST-Segment Elevation Myocardial Infarction Patients at FMIC Hospital in Kabul, Afghanistan. · 2024 · DOI

  • However, very few studies have been conducted regarding the predisposing factors of subacute stent thrombosis (SST) in Pakistan, and hence, there is very limited knowledge regarding the trend of risk factors associated with SST.

    Predisposing factors leading to subacute stent thrombosis (SAT) in patients who have undergone percutaneous coronary intervention (PCI) in patients presenting with acute coronary syndrome · 2023 · DOI

  • INTRODUCTION: Although there are limited data on the change of Tpeak-tend (Tpe), Tpe dispersion (Tpe-d) and Tpe/QT rate, which are new predictors of ventricular arrhythmias in acute ischemic stroke (AIS) and acute hemorrhagic stroke (AHS), these parameters have not been evaluated in the transient ischemic attack (TIA).

    Tpe, Tpe Dispersion and Tpe/QT Ratio as Risk Indicators of Malign Ventricular Arrhythmia In Acute Cerebrovascular Event · 2022 · DOI

  • The metabolic pathway of cTns includes three main stages (release of cTns from MCs, circulation of cTns in blood plasma, removal of cTns from the bloodstream), each of which can have a very significant effect on the serum levels of cTns, i.e., on their diagnostic value. The format of the review, starting with the release of troponin in blood, and concluding with the metabolism/filtration of troponins, provides a comprehensive yet logically easy way for the reader to approach our current knowledge in the framework of understanding the basic mechanisms by which troponins are produced and processed. Based on the analysis of the current literature, the important role of biology and all the stages of metabolism (release, circulation, removal) of cTns in laboratory diagnostics should be noted. It is necessary to continue studying the biology and metabolism of cTns, because this will improve the differential diagnosis of MI, and create a new application of cTns immunoassays in current clinical practice. It should be noted that many new views on the biology, metabolism, and diagnostic value of cTns (in particular, the role of circadian rhythms, gender- and age-related characteristics of concentrations, the possibility of detecting cTns in urine and saliva, etc.) were formed as a result of an increase in the sensitivity of troponin immunoassays. Unfortunately, today, many stages of the metabolic pathway of cTns and factors influencing the metabolic pathway of cTns are extremely poorly understood, and are hypothetical and/or contradictory. In particular, the specific mechanisms of the release of cTns from the myocardium into the bloodstream, as affected by physiological conditions and characteristics (physical exertion, stress, circadian fluctuations in the activity of organs, and tissues that influence the release of cTns molecules) and non-ischemic pathologies, which are often accompanied by an increase in the concentration of cTns in the bloodstream, are not very well known. Moreover, factors affecting the circulation of cTns molecules in the bloodstream, in particular, enzymes involved in the metabolism (fragmentation) of troponin molecules, remain unknown. The mechanisms of filtration (transport) of cardiac troponin molecules from the bloodstream to other biological fluids are not investigated, and, accordingly, these possibilities of non-invasive diagnostics have not been validated. Thus, the study of the biology and metabolism of cTns and potential factors influencing it is a relatively large and poorly studied area for further research, which is needed to optimize diagnostics and validate new diagnostic capabilities.

    Biology of Cardiac Troponins: Emphasis on Metabolism · 2022 · DOI

  • Conclusions Females undergoing PCI for ACS are at higher risk for worse outcomes because they are more likely to express the eccentric hypertrophy phenotype; however, it did not account for the difference in adverse outcomes observed between sexes.

    The effect of cardiac geometry variation according to sex and race on outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention · 2021 · DOI

  • [4] 5][6] Nonetheless, it remains unclear how the COVID-19 pandemic has affected the invasive assessment and treatment of patients with acute myocardial infarction (AMI) in countries with a well--developed network of catheterization laboratories and a relatively slower spread of SARS -CoV-2, such as Poland.

    Decline in the number of coronary angiography and percutaneous coronary intervention procedures in patients with acute myocardial infarction in Poland during the coronavirus disease 2019 pandemic · 2020 · DOI

  • The interval between the peak of the T wave and the end of the T wave (Tpe) and the ratio of Tpe and a corrected measurement of the time from the start of the Q wave to the end of the T wave (Tpe/QTc ratio) are relatively new electrocardiogram (ECG) indices and have not yet been tested in STEMI patients treated with fibrinolytic agents.

    Admission Tpe interval predicts the reperfusion success in STEMI patients treated with fibrinolytic agents · 2019 · DOI

  • The use of highly sensitive troponin assays also carries other potential benefits associated with their predictive value, as well as challenges that include reduced specificity for myocardial infarction, lack of standardization or the presence of biological variability.

    High-sensitivity troponin assays: analytical and clinical aspects · 2016 · DOI

  • The problem of CAD in young people has not been characterised as well as in older individuals, as the available data mostly come from case reports and small series, often related to genetic aspects and familial occurrence of the disease.

    Clinical and angiographic characteristics of coronary artery disease in young adults: a single centre study · 2015 · DOI

  • Cardiac MRI with dobutamine stress and gadolinium contrast can demonstrate reversible ischaemia, but comparative diagnostic performance and clinical utility relative to MPS SPECT and CTCA specifically for troponin-negative chest pain in acute medicine settings have not been established.

    Chest pain in acute medicine · 2013 · DOI

  • Myocardial contrast perfusion changes are observable during stress and contrast echocardiography but lack the consistency and reproducibility demonstrated by myocardial perfusion scintigraphy (MPS SPECT); the specific technical barriers to achieving reproducible contrast perfusion imaging require investigation.

    Chest pain in acute medicine · 2013 · DOI

  • Contrast-enhanced CT coronary angiography (CTCA) delivers 5-6 mSv radiation dosage comparable to diagnostic coronary angiography, but optimal risk-benefit decision-making parameters comparing radiation exposure against clinical benefit from invasive intervention strategies for moderate-risk chest pain patients require further specification.

    Chest pain in acute medicine · 2013 · DOI

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89 open questions have been extracted from the limitations and future-work passages of 750 Acute Myocardial Infarction Research papers in our library. Each one below links back to the study that raised it, so you can read the original claim in context.

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