Editorial: Prognostic value of inflammatory and thrombotic biomarkers in acute coronary syndrome

Ischemic heart disease still represents the first cause of death and disability-adjusted life-year (DALYs) globally, especially in patients older than 50 years [1].Despite substantial advances in pharmacological and interventional management, acute coronary syndrome (ACS) is still associated with significant morbidity and mortality, and in-hospital and post-discharge complications remain frequent [2]. The pathogenesis of ACS is complex and multifactorial, involving both inflammatory and non-inflammatory mechanisms that contribute to plaque destabilization, including plaque rupture or erosion. [3] These processes ultimately lead to the formation of a fibrin-rich thrombus and acute coronary obstruction, resulting in myocardial ischemia and necrosis.Therefore, identification and validation of prognostic biomarkers in ACS context represent a critical step toward improving risk stratification and enabling early identification of patients at increased risk of adverse outcomes. . Biomarkers reflecting inflammatory activation, metabolic stress, and thrombotic processes may provide valuable insights into disease severity and progression, and may help guide therapeutic decision-making and patient management.Value of Inflammatory and Thrombotic Biomarkers in Acute Coronary Syndrome" aims to identify several inflammatory and thrombotic biomarkers that could be useful as diagnostic and prognostic tool for clinicians. The Research Topic consisted of eight articles that overall give an advancement in this field.interleukin 38 (IL-38), one of the latest members identified in the IL-1 cytokine family, as predictors of major cardiac events (MACE), a severe complication often occurring after a percutaneous coronary intervention (PCI): indeed, while the inflammation, suggested by high serum level of CRP was strongly associated with higher risk of MACE in post-PCI patients, serum levels of IL-38 were inversely related to MACE, probably due to the ability to bind the IL-36 receptor (IL-1R6) exhibiting anti-inflammatory properties.Xiong et al. explored the acute severe heart failure predictive value of monocyte count, monocyteto-white blood cell ratio, and monocyte-to-lymphocyte ratio in 173 patients with acute myocardial infarction. Authors found that these biomarkers were significantly higher in patients with acute severe heart failure representing potential biomarkers for this complication.Yang et al. investigated the role of Systemic Inflammatory Response Index (SIRI) defined as ([neutrophil count × monocyte count]/ lymphocyte count) in predicting myocardial infarction in patients with unstable angina. Indeed, unstable angina may evolve rapidly to myocardial infarction and inflammation had a key role in this process. For this reason, Authors investigated SIRI as potential predictor of myocardial infarction in 129 patients with unstable angina. In this study, SIRI demonstrated excellent predictive performance for myocardial infarction and resulted in an independent predictor of myocardial infarction in this population.Beyond inflammation, metabolic stress and glycemic abnormalities represent additional determinants of adverse outcomes in ACS. Wang et al. evaluated the stress hyperglycemia ratio (SHR) as potential predictor of in-hospital cardiogenic shock in 1,776 patients with ST-elevation myocardial infarction (STEMI). Authors found that SHR was independently associated with inhospital cardiogenic shock and the inclusion of SHR into established risk scores significantly improved predictive accuracy.controls evaluating if serum cyclophilin A (CyPA), a novel biomarker, could be helpful in prognosis improvement. Authors found that serum CyPA levels were significantly higher in patients with acute STEMI than in healthy controls and resulted independently associated with acute STEMI suggesting a potential role of this biomarker in the first phase of STEMI identification.Coronary Arteries (MINOCA), that accounts for up to 15% of acute myocardial infarction. As shown by this study, FnBPA5 seems to enable the selective detection of microthrombi in coronary arteries by targeting untensed fibronectin fibers, a novel mechanical biomarker of microthrombi making this biomarker a promising tool for advanced microthrombi detection.Gensini score, that quantifies coronary artery lesions and fasting blood glucose (FBG) levels in 464 STEMI patients treated with PCI. The U-shaped relationship found remarked a significant, non-linear association between FBG levels and coronary artery lesion severity, regardless of diabetes status, suggesting a potential role of FBG monitoring in STEMI patients.Finally, Pannunzio et al. summarize in a narrative review the two-way relationship between atrial fibrillation (AF) and coronary artery disease: indeed, these disorders often coexist and may represent a clinical feature that could foresee the other condition. In particular, AF and acute myocardial infarction share several mechanisms of injury, such as increased oxidative stress, systemic inflammation and increased platelet aggregation. Furthermore, the Authors described the pathophysiological difference between early AF (occurring within the first 24 hours after the index event and associated with atrial ischemia, oxidative stress and a better outcome) and late AF (occurring after 24 hours from myocardial infarction and correlated with increased left atrial pressures, deterioration of hemodynamic status, and a worse outcome) suggesting as the timing of AF onset may represent itself a clinically relevant prognostic markerof worse outcome in patients with acute myocardial infarction.In conclusion, the studies included in this Research Topic emphasize the central role of inflammatory activation, metabolic stress, and thrombotic mechanisms in determining disease severity and clinical outcomes in ACS. Emerging biomarkers reflecting these biological pathways provide valuable prognostic information and may contribute to improved risk stratification and personalized management of patients with ACS.