INTRODUCTION: Peripartum cardiomyopathy (PPCM) is a severe condition with nonspecific symptoms and limited diagnostic biomarkers. Conventional markers such as BNP and NT-proBNP lack specificity, complicating differentiat...INTRODUCTION: Peripartum cardiomyopathy (PPCM) is a severe condition with nonspecific symptoms and limited diagnostic biomarkers. Conventional markers such as BNP and NT-proBNP lack specificity, complicating differentiation from other cardiac disorders. AREAS COVERED: We conducted a comprehensive literature search in PubMed, Scopus, and Web of Science for studies published between January 2000 and August 2025 using keywords related to PPCM and biomarkers. Recent advances highlight novel markers in prolactin-mediated and angiogenic pathways. Cathepsin D shows therapeutic potential, while miR-146a offers an alternative to bromocriptine without lactation suppression. The sFlt-1/PlGF ratio aids in distinguishing PPCM from preeclampsia, though postpartum variability limits its utility. Emerging candidates such as VEGF, PlGF, adiponectin (ADIPOQ), and QSOX1 reflect diverse mechanisms, and heat shock proteins may modulate biomarker activity. EXPERT OPINION: Multi-marker strategies are essential to address PPCM heterogeneity and improve diagnostic accuracy. Future research should validate these biomarkers, refine diagnostic tools, and explore therapeutic applications to transform PPCM management and outcomes.
INTRODUCTION: The presence of acute hypertension-mediated organ damage (HMOD) makes the difference between hypertensive emergency (HTN-E) and hypertensive urgency (HTN-U). In the case of unrecognized ('false negative') a...INTRODUCTION: The presence of acute hypertension-mediated organ damage (HMOD) makes the difference between hypertensive emergency (HTN-E) and hypertensive urgency (HTN-U). In the case of unrecognized ('false negative') acute HMOD, a misclassification ensues: the diagnosis is HTN-U instead of HTN-E, and the treatment of these patients is inadequate. AREAS COVERED: This review aims to investigate the presence of undiagnosed acute HMODs in the hypertension (HTN) guidelines, to analyze the significance of the undiagnosed acute HMODs, and to evaluate the gaps in the knowledge on the topic. The following databases were searched: Scopus, PubMed, Cambridge, Oxford Journals, Springer, Science Direct, SAGE, Wiley, and Google Scholar. EXPERT OPINION: There is insufficient awareness of the problem of unrecognized ('false negative') acute HMODs in clinical practice. HTN-Es have poor prognosis, with high risk of cardiovascular events and even death. Acute HMODs are prerequisite for the diagnosis of HTN-E, and it can be expected that undetected HMODs have even worse outcome. Therefore, undetected (false - negative) acute HMODs are worth of accepting and studying.
INTRODUCTION: The Fontan procedure and its modifications have dramatically transformed prognosis in individuals with single ventricle physiology, yet long-term outcomes remain challenging due to the high incidence of sho...INTRODUCTION: The Fontan procedure and its modifications have dramatically transformed prognosis in individuals with single ventricle physiology, yet long-term outcomes remain challenging due to the high incidence of short and long-term complications. Common issues include arrhythmias, heart failure, Fontan-associated liver disease and an increasing need for reintervention or transplantation, all of which substantially impact on patients' quality of life and longevity. As this population ages, late cardiac and extracardiac complications are common, which underscores the need for ongoing monitoring and comprehensive multidisciplinary care aimed at early and effective management. AREAS COVERED: This review summarizes current evidence on the long-term outcomes after Fontan-type surgery. It describes the unique pathophysiology of the Fontan circuit, and critically evaluates incidence, severity, and management strategies for common cardiac and extracardiac complications, focusing on established clinical practice and recent advances. The review also highlights the value of continued specialist multidisciplinary care. EXPERT OPINION: Emerging research supports the potential of novel medical therapies and devices to further improve outcomes, yet optimal care remains grounded in multidisciplinary management rather than experimental approaches. Continued research is vital to support clinical guidelines and improve the quality of life and outcomes of individuals living with a Fontan-type circulation.
INTRODUCTION: Transcatheter aortic valve implantation (TAVI) has revolutionized the treatment of severe aortic stenosis, yet conduction disturbances remain the most common complication. Permanent pacemaker implantation (...INTRODUCTION: Transcatheter aortic valve implantation (TAVI) has revolutionized the treatment of severe aortic stenosis, yet conduction disturbances remain the most common complication. Permanent pacemaker implantation (PPI), while often necessary, may negatively impact long-term outcomes and increase healthcare burden. Identifying patients at risk of PPI and optimizing post-TAVI rhythm management is therefore of critical importance. AREAS COVERED: This Special Report reviews key predictors of conduction disturbances after TAVI, including baseline electrocardiographic features (e.g. right bundle branch block), anatomical parameters (e.g. short membranous septum), and procedural factors (e.g. valve type and implantation depth) identified by literature review. Dynamic post-procedural changes in PR interval and QRS duration are discussed as triggers for further monitoring or electrophysiological testing. The report synthesizes findings from recent multicenter studies, guideline recommendations, and emerging tools such as ECG ambulatory monitoring using artificial intelligence and the MIDAS implantation technique. EXPERT OPINION: Reducing unnecessary PPI requires an individualized, risk-adapted approach that integrates imaging, ECG, and procedural planning. Dynamic post-TAVI monitoring and selective use of electrophysiological studies may help avoid overtreatment. As TAVI expands to younger and lower-risk populations, refining conduction management will be essential to optimize patient outcomes and healthcare resource utilization.
OBJECTIVES: This systematic review and meta-analysis focused on summarizing and quantitatively estimating the pooled adherence rates to clinical guideline recommendations for anticoagulation therapy in patients with AF r...OBJECTIVES: This systematic review and meta-analysis focused on summarizing and quantitatively estimating the pooled adherence rates to clinical guideline recommendations for anticoagulation therapy in patients with AF receiving treatment in Ethiopian hospitals. METHODS: The Systematic literature search was conducted in PubMed, Cochrane Library, Africa-specific databases (African Index Medicus, and African Journals Online), and Google Scholar. Data were extracted in a structured format prepared using Microsoft Excel. The extracted data were exported to R software Version 4.3.0 for analysis. The I2 test was used to check the heterogeneity between primary studies with a corresponding 95% confidence interval (CI). Based on the test result, a random-effects meta-analysis model was used to estimate pooled effect adherence rate to the international guideline in antithrombotic therapy. RESULTS: The review included a total of 6 primary studies with the pooled adherence rate to guidelines in antithrombotic therapy use in patients diagnosed with AF who are at high risk for thromboembolic events and eligible for oral anticoagulants was found to be 55% (95% CI: 33% to 77%). CONCLUSION: Guideline adherence for oral antithrombotic therapy was low (55%), leaving many high-risk patients vulnerable. Multifaceted interventions, including coordinated care and pharmacist involvement, are needed to improve adherence.
INTRODUCTION: Cardiac Troponin (cTn) is fundamental to the diagnosis of myocardial injury. High sensitivity cTn assays have transformed acute cardiac care by shifting the focus toward rapid rule-out of myocardial infarct...INTRODUCTION: Cardiac Troponin (cTn) is fundamental to the diagnosis of myocardial injury. High sensitivity cTn assays have transformed acute cardiac care by shifting the focus toward rapid rule-out of myocardial infarction, allowing the early identification and safe discharge of low-risk patients. However, cTn proteins and their assays have limitations. AREAS COVERED: The review summarizes cTn as a biomarker of myocardial injury, high-sensitivity cTn assay performance, and their combined impact on chest pain pathways. It explores Cardiac Myosin-Binding Protein C (cMyC) and discusses the evidence behind its use as an alternative biomarker. Studies available on Pubmed were analyzed using keywords cTn, cMyC, myocardial infarction, triage, chest pain and assay. The second half of this review explores the proteolysis of both these biomarkers, and how this information could be used in clinical practice. EXPERT OPINION: Both hs-cTn and hs-cMyC assays have shown equivalent diagnostic performance in the rule-out of myocardial infarction. Unfortunately, both are also plagued by the similar liabilities: decreased specificity for Type 1 AMI, and an inability to distinguish between types of myocardial injury. Proteolysis of each biomarker differs according to underlying pathology. Novel assays that quantify distinct forms could enhance patient triage.
INTRODUCTION: Conduction system pacing (CSP) is redefining management of patients requiring permanent pacing by offering a more physiologic alternative to subpulmonary ventricular pacing and conventional cardiac resynchr...INTRODUCTION: Conduction system pacing (CSP) is redefining management of patients requiring permanent pacing by offering a more physiologic alternative to subpulmonary ventricular pacing and conventional cardiac resynchronization therapy (CRT). While most evidence stems from acquired heart disease, CSP is gaining traction in congenital heart disease, where traditional pacing can exacerbate dyssynchrony and lead to long-term ventricular dysfunction. AREAS COVERED: This review examines the role of CSP in congenital heart disease, focusing on anatomical variability of the atrioventricular conduction system and lesion-specific challenges affecting lead placement. It synthesizes early data on the feasibility and safety of His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) across a range of congenital lesions. Technological advances, including CT-based conduction mapping, electroanatomic mapping, and intracardiac echocardiography, enable anatomy-guided implantation strategies. Advances in delivery tools are expanding CSP use in anatomically complex settings. Despite encouraging early results, long-term data are limited, and randomized trials are lacking. EXPERT OPINION: CSP holds the potential to become the default physiologic pacing strategy in congenital heart disease. With advancing tools and operator experience, lesion-specific and hybrid CSP - CRT techniques may optimize outcomes. Key priorities include refining patient selection, defining preventive indications, and developing guidelines to support broader adoption.
INTRODUCTION: Acute coronary syndromes (ACS) remain the leading cause of mortality in developed countries, particularly affecting older adults. Managing vulnerable patients - particularly those who are frail or have sign...INTRODUCTION: Acute coronary syndromes (ACS) remain the leading cause of mortality in developed countries, particularly affecting older adults. Managing vulnerable patients - particularly those who are frail or have significant comorbidities such as anemia or chronic kidney disease (CKD) - is challenging due to the lack of evidence-based guidelines tailored to this group. AREAS COVERED: This review explores the management of non-ST-elevation acute coronary syndrome (NST-ACS) with a focus on antithrombotic therapy, invasive strategies, and cardiac rehabilitation (CR). Special attention is given to patients with frailty, atrial fibrillation (AF), and CKD, recognizing their complexity. For this purpose, studies specifically addressing the management of elderly patients with NST-ACS were reviewed. EXPERT OPINION: Optimal management of elderly patients with NSTE-ACS requires a personalized approach. Antithrombotic therapy should be individualized, avoiding rigid guidelines. Less potent antiplatelet agents (e.g. clopidogrel) combined with direct oral anticoagulants (DOACs) offer improved safety in patients with AF. Early invasive strategies can reduce adverse events but may carry procedural risks in frail individuals. Systematic comprehensive geriatric assessment (CGA) should guide decision-making; and multidisciplinary care is essential to improving outcomes. Home-based or hybrid CR programs still need to be widely implemented and the integration of caregivers into them can enhance outcomes.
INTRODUCTION: Acute pulmonary embolism (PE) is a cardiovascular life-threatening condition associated with significant morbidity and mortality worldwide. Hemodynamic instability is a critical determinant of outcomes in P...INTRODUCTION: Acute pulmonary embolism (PE) is a cardiovascular life-threatening condition associated with significant morbidity and mortality worldwide. Hemodynamic instability is a critical determinant of outcomes in PE, underscoring the need for precise risk stratification and management. AREAS COVERED: This review highlights the importance of understanding key hemodynamic parameters in the pathophysiology of PE, emphasizing the role of advanced assessments such as diastolic blood pressure and mean arterial pressure in refining risk stratification. EXPERT OPINION: These parameters may offer a more comprehensive evaluation of cardiac function and perfusion, particularly in intermediate-risk patients where subtle hemodynamic compromise may not be evident with traditional measures. By integrating these advanced assessments into risk models, clinicians can develop personalized therapeutic strategies tailored to individual patient needs, ultimately enhancing hemodynamic outcomes and improving the effectiveness of PE management.
INTRODUCTION: Thirst is a common yet underrecognized symptom in patients with heart failure (HF), exerting a significant impact on disease management, treatment adherence, and quality of life (QoL). Approximately 65-75%...INTRODUCTION: Thirst is a common yet underrecognized symptom in patients with heart failure (HF), exerting a significant impact on disease management, treatment adherence, and quality of life (QoL). Approximately 65-75% of patients with HF report moderate to severe thirst, particularly in advanced stages of the disease or under strict fluid restrictions contributing to psychological distress, social isolation, and diminished well-being. AREAS COVERED: This systematic review explores the pathophysiology, clinical consequences, and management of thirst in HF. A literature search of PubMed, Embase, Scopus, and Web of Science (2015-2025) identified studies addressing thirst prevalence, neurohormonal and electrolyte mechanisms, and therapeutic interventions. Severe thirst has been associated with poor adherence to fluid restriction, increased psychological distress, and a 40% higher risk of hospital readmission within six months of discharge. Patient-centered strategies, such as structured education and follow-up programs, have been shown to improve adherence and reduce thirst burden. EXPERT OPINION: Despite its clinical importance, thirst remains underaddressed in HF care, with fewer than 20% of studies evaluating it as an outcome. The development of standardized assessment tools, implementation of long-term intervention studies, and incorporation of thirst management into routine HF care are essential steps toward improving patient outcomes and QoL.
INTRODUCTION: In the last decade, technological advancements in procedural devices and techniques as the increasing recognition of the prognostic relevance of bleeding after percutaneous coronary intervention (PCI) paved...INTRODUCTION: In the last decade, technological advancements in procedural devices and techniques as the increasing recognition of the prognostic relevance of bleeding after percutaneous coronary intervention (PCI) paved the way forward to the investigation of different modulation strategies of dual antiplatelet therapy (DAPT) intensity and duration. AREAS COVERED: The present review provides an update overview on DAPT modulation strategies with a specific focus in acute coronary syndromes (ACS) or chronic coronary syndromes (CCS) patients undergoing PCI stratified by the presence of high bleeding risk (HBR) features. We searched PubMed (MEDLINE), Web of Science and Cochrane Library databases from inception to August 2025 using combinations of appropriate keywords. EXPERT OPINION: Current evidence supports a shift in the post-PCI antithrombotic paradigm toward early aspirin discontinuation and transitioning to P2Y₁₂ inhibitor monotherapy, particularly in patients with HBR. While there is increasing evidence for ticagrelor monotherapy in patients with ACS, clopidogrel-based strategies may be considered in selected patients, particularly those with CCS and/or or low thrombotic risk. A patient-centered, tailored approach should remain key to guide the selection and duration of antiplatelet therapy after PCI.
Di Leo M, Vasumini N, Maida A
… +15 more, Manaresi T, Basile M, Angeli F, Armillotta M, Casuso Alvarez M, Bavuso LL, Belà R, Salerno J, Fedele D, Canton L, Amicone S, Carletti R, Gardini E, Bergamaschi L, Pizzi C
INTRODUCTION: Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) represents a diagnostic challenge, requiring the exclusion of non-ischemic causes such as myocarditis, Takotsubo syndrome, and cardiomyo...INTRODUCTION: Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) represents a diagnostic challenge, requiring the exclusion of non-ischemic causes such as myocarditis, Takotsubo syndrome, and cardiomyopathies. Cardiac magnetic resonance (CMR) plays a pivotal role in differentiating MINOCA from these conditions by providing detailed tissue characterization to identify inflammation, edema, and fibrosis. This review explores the expanding role of CMR in diagnosing, reclassifying, and managing MINOCA, emphasizing its ability to guide treatment, improve prognosis, and aid risk stratification by identifying underlying causes. AREAS COVERED: This narrative review discusses recent advancements in CMR protocols for suspected MINOCA, its role in distinguishing ischemic from non-ischemic causes of acute myocardial injury, and its emerging utility in risk stratification and personalized therapy. Relevant articles were searched in PubMed, Scopus, and Cochrane databases up to February 2025. EXPERT OPINION: CMR is the noninvasive gold standard for diagnosing MINOCA. Its emerging role in evaluating coronary microcirculation, along with integrated approaches using coronary computed tomography, will further enhance the noninvasive assessment of MINOCA, in particular determining potential coronary and non-coronary etiologies.
INTRODUCTION: Coronary artery disease (CAD) is a major global cause of morbidity and mortality. Percutaneous coronary intervention (PCI) is central to its management, and optimal stent deployment is critical. This system...INTRODUCTION: Coronary artery disease (CAD) is a major global cause of morbidity and mortality. Percutaneous coronary intervention (PCI) is central to its management, and optimal stent deployment is critical. This systematic review evaluates the efficacy and clinical outcomes associated with enhanced stent visualization (ESV) systems - X-ray-based fluoroscopic tools such as StentBoost and CLEARstent - in PCI. METHODS: A systematic literature search of PubMed, PubMed Central, and Cochrane Library was conducted according to PRISMA guidelines. Inclusion criteria comprised all study types evaluating ESV use in PCI, excluding case reports and non-English articles. Study quality was assessed using Newcastle-Ottawa tool. RESULTS: Twelve studies involving ESV were included. ESV improved detection of stent expansion and deployment versus standard angiography and showed strong agreement with OCT and IVUS. ESV-guided PCI was associated with reduced rates of major adverse cardiac events (MACE), particularly in long-term follow-up. Radiation exposure was modestly increased but deemed acceptable. CONCLUSIONS: ESV systems enhance stent deployment accuracy and clinical outcomes in PCI, offering a cost-effective and accessible alternative to OCT and IVUS. Evidence supports routine integration of ESV in PCI workflows, although further large-scale trials are warranted. REGISTRATION: PROSPERO identifier is CRD420251020834.
BACKGROUND: Non-dipper blood pressure (BP) patterns are associated with increased cardiovascular risk, but their relationship to coronary artery disease (CAD) complexity remains unclear. This study evaluated whether a no...BACKGROUND: Non-dipper blood pressure (BP) patterns are associated with increased cardiovascular risk, but their relationship to coronary artery disease (CAD) complexity remains unclear. This study evaluated whether a non-dipper BP profile is linked to greater CAD burden in hypertensive patients using SYNTAX Scores (SS) I and II. RESEARCH DESIGN AND METHODS: A total of 381 hypertensive patients undergoing elective coronary angiography were prospectively enrolled. All underwent 24-hour ambulatory BP monitoring (ABPM) and were categorized as dipper or non-dipper. CAD burden was assessed using SS I and II. ROC analysis and multivariate logistic regression were performed. RESULTS: Non-dippers had significantly higher SS I (14.24 ± 8.47 vs. 9.81 ± 5.24) and SS II (28.64 ± 9.64 vs. 22.30 ± 6.57) than dippers ( < 0.001). SS II had greater predictive value (AUC: 0.704). Non-dipper status (OR: 20.1), diabetes, lower eGFR, and higher platelet count were independently associated with high SS, while age, gender, and high-sensitivity C-reactive protein (hs-CRP) were not. CONCLUSIONS: Non-dipper BP was independently associated with greater anatomical and clinical CAD complexity. Integrating ABPM and SS may enhance cardiovascular risk stratification and inform individualized preventive strategies in hypertensive patients.
INTRODUCTION: Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of global morbidity and mortality, with elevated low-density lipoprotein cholesterol (LDL-C) established as a primary causal factor. De...INTRODUCTION: Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of global morbidity and mortality, with elevated low-density lipoprotein cholesterol (LDL-C) established as a primary causal factor. Despite foundational therapies, many high-risk patients fail to achieve optimal LDL-C targets. AREAS COVERED: This review examines established LDL-C lowering agents (statins and ezetimibe), detailing their mechanisms and limitations, including statin intolerance and residual cardiovascular risk. We provide a comprehensive analysis of novel therapeutic options, including proprotein convertase subtilisin/kexin type 9 (PCSK9) modulators (monoclonal antibodies, small interfering RNA, and emerging oral agents), ATP-citrate lyase inhibitors (bempedoic acid), angiopoietin-like protein 3 (ANGPTL3) inhibitors, and pioneering gene-editing technologies. We discuss mechanisms of action, pivotal efficacy data (LDL-C reduction and plaque modification), safety profiles, and key findings from major cardiovascular outcome trials. EXPERT OPINION: Novel LDL-C lowering therapies represent a paradigm shift, offering unprecedented efficacy in reducing LDL-C and mitigating ASCVD risk. However, significant challenges remain, including cost-effectiveness concerns, the need for long-term safety data, profound global disparities in access, and persistent clinical inertia that impedes real-world implementation even in well-resourced healthcare systems. Future research should prioritize personalized lipid management, combination strategies, and development of durable, cost-effective solutions to reduce the residual ASCVD burden.
INTRODUCTION: High-density lipoprotein cholesterol (HDL-C) has long been regarded as 'good cholesterol,' but clinical trials and epidemiological studies have demonstrated that simply raising HDL-C levels does not reduce...INTRODUCTION: High-density lipoprotein cholesterol (HDL-C) has long been regarded as 'good cholesterol,' but clinical trials and epidemiological studies have demonstrated that simply raising HDL-C levels does not reduce cardiovascular events. Attention has therefore shifted from HDL-C quantity to HDL functionality. AREAS COVERED: This review summarizes evidence from PubMed and Web of Science (2011-2024) on cholesterol efflux capacity (CEC), the most widely studied HDL functionality. CEC reflects the ability of HDL to remove cholesterol from macrophages, representing the first step of reverse cholesterol transport. Cohort and case-control studies consistently indicate that CEC provides incremental predictive value for atherosclerotic cardiovascular disease (ASCVD) beyond traditional lipid parameters. However, results vary across familial hypercholesterolemia cohorts, highlighting the influence of assay methods, treatment exposure, and HDL remodeling. The review also addresses lifestyle and genetic factors (e.g. alcohol consumption, polymorphisms), oxidative stress, and methodological challenges that complicate CEC measurement and standardization. EXPERT OPINION: While CEC is a promising surrogate marker, it remains a phenomenon rather than a therapeutic target, and there is no conclusive evidence that increasing CEC reduces ASCVD events. Future research should focus on disease-specific molecules, such as FABP5 and ORM1, that impair HDL function. Identifying these pathways may yield novel biomarkers and therapeutic targets, offering a more precise approach to residual cardiovascular risk beyond HDL-C levels.
INTRODUCTION: Catheter ablation has traditionally been performed using thermal modalities, which, despite being effective, remain associated with potentially severe complications such as pulmonary vein stenosis and atrio...INTRODUCTION: Catheter ablation has traditionally been performed using thermal modalities, which, despite being effective, remain associated with potentially severe complications such as pulmonary vein stenosis and atrioesophageal fistula. Pulsed field ablation (PFA), a non-thermal technique based on irreversible electroporation, has emerged as a promising alternative, with the potential to maintain the efficacy of thermal energies while minimizing collateral damage to surrounding structures. AREAS COVERED: This review discusses the safety and efficacy of PFA for atrial fibrillation (AF) ablation. We analyzed the latest clinical evidence on PFA lesion durability and effectiveness, integrating insights from our clinical experience and workflow. The safety profile of PFA is critically examined, highlighting its advantages in reducing complications while addressing emerging PFA-specific adverse effects such as hemolysis and coronary vasospasm. EXPERT OPINION: PFA promises to overcome the safety limitations encountered during AF ablation with thermal modalities. This may permit earlier referrals, treatment of more complex patients, and adoption of a more individualized, extensive ablation approach. Despite this, PFA still requires technological and workflow optimization due to challenges in lesion durability, real-time lesion assessment, and emerging concerns about energy-specific side effects. These issues require operator awareness and are expected to be addressed with second-generation PFA systems.
INTRODUCTION: Atherosclerosis, the primary cause of coronary artery disease (CAD), progresses through subclinical, chronic, and acute phases, culminating in acute myocardial infarction (AMI). Historically viewed as a lip...INTRODUCTION: Atherosclerosis, the primary cause of coronary artery disease (CAD), progresses through subclinical, chronic, and acute phases, culminating in acute myocardial infarction (AMI). Historically viewed as a lipid-driven disorder, it is now recognized as an inflammatory disease. Despite achieving optimal low-density lipoprotein cholesterol reduction, many patients experience residual cardiovascular risk, largely attributed to persistent inflammation. AREAS COVERED: A comprehensive literature search has been performed on PubMed, Web of Science and Cochrane, up to July 2025, with no significant restrictions. The review explores the role of inflammation in plaque progression and destabilization, discusses emerging biomarkers for risk stratification, and summarizes current and investigational anti-inflammatory therapies. Special attention is given to the evolving understanding of acute versus chronic post-AMI inflammation and how this distinction may guide therapeutic strategies. EXPERT OPINION: Anti-inflammatory therapy has reshaped the landscape of cardiovascular prevention, yet challenges remain in patient selection, timing, and target identification. Novel imaging techniques and artificial intelligence-driven risk models offer promising avenues for personalized therapy. Future efforts should focus on precision-based approaches that target detrimental immune activation while preserving reparative processes, ensuring maximal clinical benefit.