Vol. 7, Issue 2, Part A (2025)

Acute Coronary Syndromes (ACS) represent a spectrum of clinical manifestations of ischemic heart disease, encompassing conditions such as unstable angina, non-ST-elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI). Early diagnosis and accurate prognosis are critical to improving patient outcomes, but current biomarkers have limitations in sensitivity and specificity. Recently, microRNAs (miRNAs) have emerged as key regulators in cardiovascular disease, with several studies highlighting their potential as biomarkers in ACS. These small non-coding RNAs regulate gene expression post-transcriptionally, influencing various cardiovascular processes, including inflammation, apoptosis, and endothelial function. In ACS, dysregulated miRNA expression has been associated with the development and progression of the disease. Elevated or decreased levels of specific miRNAs in the bloodstream have been linked to the presence of ACS and its severity. Moreover, miRNAs offer promising prognostic value, with particular miRNA signatures correlating with adverse clinical outcomes, such as mortality, recurrent infarction, and heart failure. The present review aims to provide an overview of the current understanding of miRNA involvement in ACS, exploring their diagnostic and prognostic potential. We discuss various miRNA candidates identified in ACS, their mechanisms of action, and the challenges of integrating miRNAs into clinical practice. Despite the promising data, the application of miRNAs as diagnostic and prognostic tools remains in the experimental phase, requiring further validation through large-scale clinical studies. This article also outlines the hurdles in translating miRNA-based assays from research to clinical implementation, including the need for standardization, validation, and cost-effectiveness considerations. Finally, we provide insights into the future directions of miRNA-based diagnostics and therapeutics in ACS, aiming to enhance the precision of cardiovascular care.