Precision Medicine in Acute Coronary Syndromes: Integrating Plaque Phenotyping, Personalized Revascularization, Antithrombotic Strategies, and Residual Risk Reduction
5 affiliations
- 1RAK College of Medical Sciences, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah 11172, United Arab Emirates
- 2Department of Community Medicine, RAK College of Medical Sciences, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah 11172, United Arab Emirates
- 3Department of Microbiology, RAK College of Medical Sciences, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah 11172, United Arab Emirates
- 4Department of Anatomy, RAK College of Medical Sciences, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah 11172, United Arab Emirates
- 5RAK College of Nursing, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah 11172, United Arab Emirates
Abstract
Acute coronary syndromes (ACS) are biologically and clinically heterogeneous, with substantial variation in mechanisms of coronary instability, coronary anatomy, ischemic and bleeding risk, and residual cardiovascular risk. Although advances in imaging, risk stratification, and targeted therapies have expanded opportunities for individualized care, their clinical actionability remains uneven. This narrative review proposes a longitudinal precision-medicine framework integrating four interconnected domains—mechanism, anatomy, ischemic–bleeding risk, and residual biological risk—to examine how patient characterization can inform treatment selection and reassessment. Contemporary evidence on mechanistic phenotyping, coronary imaging, revascularization, antithrombotic therapy, and residual cardiovascular risk is critically synthesized, with particular emphasis on distinguishing strategies supported by randomized clinical-outcome evidence from those supported primarily by mechanistic, imaging, biomarker, or other surrogate endpoints. Mechanistic and imaging-based characterization can refine ACS phenotyping, while coronary anatomy and clinical characteristics inform revascularization decisions. Dynamic assessment of ischemic and bleeding risk supports individualized antithrombotic strategies, and lipid-related, inflammatory, thrombotic, and cardiometabolic phenotypes inform residual-risk assessment and secondary prevention. However, the evidence supporting phenotype-guided treatment remains heterogeneous. Several anatomy- and risk-informed strategies have demonstrated clinical benefit, whereas morphology-guided intervention, biomarker-directed treatment, molecular phenotyping, and artificial-intelligence-assisted decision support require further validation before routine implementation. The proposed framework distinguishes clinically actionable information from findings that remain primarily prognostic or hypothesis-generating. Diagnostic precision currently exceeds therapeutic precision in several areas of ACS care. A longitudinal framework integrating mechanism, anatomy, ischemic–bleeding risk, and residual biological risk may help connect patient phenotyping to evidence-based treatment decisions, identify where treatment-effect evidence remains insufficient, and support reassessment as clinical and biological risk evolves. Precision ACS care should therefore prioritize demonstrated clinical benefit rather than diagnostic sophistication alone.
Related
- Personalized Cardiac Rehabilitation: Integrating Biomarker-Guided, Technology-Enabled, and Population-Specific Strategies in Exercise Medicine.
- NETs and the thrombo-immune microenvironment: immune heterogeneity in recanalization, reperfusion, hemorrhagic transformation, and antithrombotic strategies
- OVER-TIME II trial: design and rationale of a multicentre randomized study evaluating antithrombotic strategies in patients with acute coronary syndrome and coronary artery ectasia
- Perioperative Outcomes of Multivessel Minimally Invasive Coronary Revascularization at a Specialized Center: A Retrospective Cohort of Complete Surgical and Planned Hybrid Strategies
- Comparative midterm outcomes of contemporary revascularization strategies for acute lower limb ischemia: a retrospective cohort study
BibTeX
@article{omari2026precision,
title = {{Precision Medicine in Acute Coronary Syndromes: Integrating Plaque Phenotyping, Personalized Revascularization, Antithrombotic Strategies, and Residual Risk Reduction}},
author = {Ahmad Omari and Yazeed Omari and Ahmad Kharoufeh and Mohamedanas Mohamedfaruk Patni and Thilakavathy Pandurangan and Abdalla Ahmed Eldaw Elamin and Ramya Kundayi Ravi and Omar Emad Khater and Mohammadnour Malkawi and Omar Aldwiri},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15218248},
url = {https://www.mdpi.com/2077-0383/15/21/8248},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Precision Medicine in Acute Coronary Syndromes: Integrating Plaque Phenotyping, Personalized Revascularization, Antithrombotic Strategies, and Residual Risk Reduction
AU - Ahmad Omari
AU - Yazeed Omari
AU - Ahmad Kharoufeh
AU - Mohamedanas Mohamedfaruk Patni
AU - Thilakavathy Pandurangan
AU - Abdalla Ahmed Eldaw Elamin
AU - Ramya Kundayi Ravi
AU - Omar Emad Khater
AU - Mohammadnour Malkawi
AU - Omar Aldwiri
PY - 2026
DA - 2026/10/23
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218248
UR - https://www.mdpi.com/2077-0383/15/21/8248
AB - Acute coronary syndromes (ACS) are biologically and clinically heterogeneous, with substantial variation in mechanisms of coronary instability, coronary anatomy, ischemic and bleeding risk, and residual cardiovascular risk. Although advances in imaging, risk stratification, and targeted therapies have expanded opportunities for individualized care, their clinical actionability remains uneven. This narrative review proposes a longitudinal precision-medicine framework integrating four interconnected domains—mechanism, anatomy, ischemic–bleeding risk, and residual biological risk—to examine how patient characterization can inform treatment selection and reassessment. Contemporary evidence on mechanistic phenotyping, coronary imaging, revascularization, antithrombotic therapy, and residual cardiovascular risk is critically synthesized, with particular emphasis on distinguishing strategies supported by randomized clinical-outcome evidence from those supported primarily by mechanistic, imaging, biomarker, or other surrogate endpoints. Mechanistic and imaging-based characterization can refine ACS phenotyping, while coronary anatomy and clinical characteristics inform revascularization decisions. Dynamic assessment of ischemic and bleeding risk supports individualized antithrombotic strategies, and lipid-related, inflammatory, thrombotic, and cardiometabolic phenotypes inform residual-risk assessment and secondary prevention. However, the evidence supporting phenotype-guided treatment remains heterogeneous. Several anatomy- and risk-informed strategies have demonstrated clinical benefit, whereas morphology-guided intervention, biomarker-directed treatment, molecular phenotyping, and artificial-intelligence-assisted decision support require further validation before routine implementation. The proposed framework distinguishes clinically actionable information from findings that remain primarily prognostic or hypothesis-generating. Diagnostic precision currently exceeds therapeutic precision in several areas of ACS care. A longitudinal framework integrating mechanism, anatomy, ischemic–bleeding risk, and residual biological risk may help connect patient phenotyping to evidence-based treatment decisions, identify where treatment-effect evidence remains insufficient, and support reassessment as clinical and biological risk evolves. Precision ACS care should therefore prioritize demonstrated clinical benefit rather than diagnostic sophistication alone.
SN - 2077-0383
ER -