The role of inflammation in acute coronary syndrome: A systematic review on biochemical inflammatory assessment and anti-inflammatory therapies

Aims: Low-grade inflammation is a key driver of the pathogenesis and complications of acute coronary syndromes (ACS), playing a central role in plaque development and destabilization. This systematic review provides a comprehensive analysis of evidence from observational studies and clinical trials, exploring the implications of inflammatory pathways in ACS patients. Data synthesis: We systematically reviewed inflammatory biomarkers evaluated in ACS patients (white blood cell count, fibrinogen, C-reactive protein, tumor necrosis factor - α, CD40-ligand, interleukin-6, interleukin-18, osteoprotegerin, calprotectin, mean platelet volume, neutrophil percentage albumin ratio, neutrophil-lymphocyte ratio, systemic inflammatory index, platelet-lymphocyte ratio and C-reactive protein/albumin ratio). Furthermore, we reviewed also the already published (mainly on colchicine) and the on-going trial on anti-inflammatory therapies in ACS patients. Conclusion: This review highlights the emerging role of inflammation in evaluating residual cardiovascular risk and focus on possible therapies that could modulate inflammation and improve outcomes in ACS patients particularly in the one at higher risk (i.e. extreme CV risk).