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Background: The recent introduction of ecological momentary assessment (EMA) smartphone-based strategies has allowed achieving some interesting data on the frequency of different awake bruxism (AB) behaviors reported by an individual in the natural environment. Objective: The present paper aims to review the literature on the reported frequency of AB based on data gathered via smartphone EMA technology. Methods: On September 2022, a systematic search in the Pubmed, Scopus and Google Scholar databases was performed to identify all peer-reviewed English-language studies assessing awake bruxism behaviors using a smartphone-based Ecological Momentary Assessment. The selected articles were assessed independently by two authors according to a structured reading of the articles’ format (PICO). Results: A literature search, for which the search terms “Awake Bruxism” and “Ecological Momentary Assessment” were used, identified 15 articles. Of them, eight fulfilled the inclusion criteria. The results of seven studies using the same smartphone-based app reported a frequency of AB behaviors in the range between 28.3 and 40% over one week, while another investigation adopted a different smartphone-based EMA approach via WhatsApp using a web-based survey program and reported an AB frequency of 58.6%. Most included studies were based on convenience samples with limited age range, highlighting the need for more studies on other population samples. Conclusions: Despite the methodological limits, the results of the reviewed studies provide a standpoint for comparison for future studies on the epidemiology of awake bruxism behaviors.

Self-reported awake bruxism (AB) has been associated with temporomandibular disorders (TMD). However, the daily amount of AB behavior has not been quantified in pain patients. Therefore, this study aimed to assess AB frequency in patients with myofascial pain and temporomandibular joint (TMJ) pain and compare it to a group of pain-free individuals. Eighty-four individuals belonging to either a TMD group (n = 54) or a healthy control group (n = 30) were selected. AB frequency was obtained by ecological momentary assessment with a dedicated smartphone application that sent sound alerts at random intervals during the day for one week. Upon receiving the alert, the volunteer reported the current muscular condition and/or the teeth position, i.e., relaxed jaw muscle, jaw bracing, teeth contact, teeth clenching, or teeth grinding. Data were evaluated by independent t-test (α = 0.05). During the seven days, AB frequency was 62.1% ± 26.8% for TMD patients and 36.2% ± 27.3% for pain-free subjects (p < 0.001). Mandible bracing was most common in the TMD group (p < 0.001), while teeth contact, clenching, and grinding did not differ between groups. Moreover, no differences were found in AB frequency between myofascial pain and TMJ pain patients. Therefore, TMD patients have higher AB frequency characterized by jaw bracing, irrespective of pain location.

Obstructive sleep apnea (OSA) is the most common sleep disorder due mainly to peripheral causes, characterized by repeated episodes of obstruction of the upper airways, associated with arousals and snoring. Sleep bruxism (SB) is a masticatory muscle activity during sleep that is characterized as rhythmic (phasic) or nonrhythmic (tonic) and is not a movement disorder or a sleep disorder in otherwise healthy individuals. Given the potentially severe consequences and complications of apnea, the concurrent high prevalence of SB in daily dental practice, getting deeper into the correlation between these phenomena is worthy of interest..The aim of this study was to investigate the correlation between SB-related masseter muscle activity (MMA) and apnea-hypopnea events as well as to assess their temporal sequence.Thirty (N = 30) patients with sleep respiratory disorders and clinical suspicion of sleep bruxism (SB) were recruited. Ambulatory polygraphic recording was performed to detect apnea-hypopnea events (AHEs) and sleep bruxism episodes (SBEs). Pearson test was used to assess the correlation between apnea-hypopnea index (AHI) and SB index (SBI). A 5-s time window with respect to the respiratory events was considered to describe the temporal distribution of SBEs. Furthermore, SBI was compared between groups of patients with different AHI severity (i.e., mild, moderate and severe) using ANOVA.On average, AHI was 27.1 ± 21.8 and SBI 9.1 ± 7.5. No correlation was shown between AHI and SBI. Most of SBEs (66.8%) occurred without a temporal relationship with respiratory events. Considering OSA, 65.7% of SBEs occurred within 5 s after AHEs, while in the case of central apnea (CA) 83.8% of SBEs occurred before the respiratory event. The participants with severe apnea (N = 9) show a tendency to have higher bruxism indexes when compared to patients with mild (N = 11) and moderate apnea (N = 10).Findings suggest that: 1. At the study population level, there is no correlation between AHI and SBI, as well as any temporal relationship between SBEs and respiratory events. 2. Specific patterns of temporal relationship might be identified with future studies focusing on the different types of apnea-hypopnea events and bruxism activities.

Objective To investigate the effect of the Coronavirus pandemic on the report of psychological status, bruxism, and TMD symptoms. Methods An online survey was drafted to report the presence of psychological status, bruxism activities, and reported symptoms of TMDs perceived during the COVID-19 pandemic in a population of 506 individuals. Results Mental health is not positive during the Coronavirus pandemic: almost half the subjects reported an increase in bruxism behaviors, while up to one-third reported an increase in their symptoms involving the TMJ and jaw muscles. Specifically, 36% and 32.2% of participants reported increased pain in the TMJ and facial muscles, respectively, and almost 50% of the subjects also reported more frequent migraines and/or headaches. Conclusion Increased psychosocial distress during the COVID-19 pandemic can increase the frequency of TMD symptoms and bruxism behaviors, which, in turn, constitute a triangle of mutually interacting factors with the psychological and emotional status.

Objective: The instrumental measurement of electromyographic (EMG) activity in the natural environment is the best strategy available to collect information on bruxism. The twofold aim of this study was to (1) introduce and discuss a novel EMG device for the assessment of awake (AB) and sleep bruxism (SB) in the home environment over 24 h and (2) present some preliminary data. Methods: Fifteen healthy volunteers (eight males and seven females; mean age: 48.2 ± 4.1 years) underwent 24 h EMG recording trials of their masseter muscle activity (MMA) with a miniaturized wireless device. This device allowed us to measure the durations of the different phases of the recordings (total duration, awake time, sleep time, and electrode dislodgement time) as well as the bruxism time index (BTI) and bruxism work index (BWI) for both the waking and sleeping hours. Results: For the healthy volunteers, on average, the bruxism work index (BWI) values were 0.4 ± 0.2 and 0.1 ± 0.1 for awake and sleep, respectively, while the mean bruxism time index (BTI) values were 0.9 ± 0.5 for awake and 0.3 ± 0.1 for sleep. Conclusions: This investigation describes the technical features of a novel EMG recording device that permits the evaluation of masseter muscle activity in the home environment over 24 h. For the first time, a dedicated elaboration of the EMG signal allowed an assessment of muscle work and not just a count of purported SB/EMG events. Clinical significance: Based on the multidisciplinary approach in the study of bruxism, such a methodology, thanks to its peculiar features, will allow researchers and clinicians to monitor the epidemiology of MMA and delve deeper into the awake and sleep bruxism correlates for tailored management in clinical settings.

Confinement by COVID-19 was a stressful period that could potentially trigger awake bruxism (AB) and/or sleep bruxism (SB) behaviors. This study aims to characterize the AB and SB behaviors reported by Portuguese dental students before the pandemic and during the first period of mandatory confinement by COVID-19. Dental students were included in this longitudinal study. They answered the Portuguese validated version of the Oral Behavior Checklist (OBC) before the COVID-19 pandemic emerged (T1) and one month after mandatory confinement started in Portugal (T2). Descriptive statistics and the linear-by-linear association test were performed to assess changes over time (p ≤ 0.05). Sixty-four dental students (mean age 22.5 ± 2.8 years; 81.5% females) completed the study protocol. Considering AB, there was a general increase of the behavior from T1 to T2. The percentage of participants who reported to “grind their teeth when waking up” just few times decreased (p < 0.001) and the percentage of participants who reported “feeling discomfort/tension in the facial muscles when waking up just few times” increased (p = 0.019). Considering SB, there was a significant decrease of the behavior in all samples. The number of “None” report to grinding teeth during sleep or when waking up increased (p = 0.012). An increase in the self-reporting of feeling discomfort in masticatory muscles when awake or sleeping was observed (p = 0.028). The percentage of participants who did “not remember” any AB or SB activity decreased (p < 0.050). The confinement due to COVID-19 resulted in a forced change in dental students’ lifestyles that resulted in an increase of reported AB and a decrease of reported SB. Clinical Significance: In case of confinement periods, students should be encouraged to try normalizing their daily life by creating healthy routines and, by doing so, reducing the possible predisposition to bruxism and its consequences.

Awake bruxism (AB) is differentiated from sleep bruxism (SB) by the differences in etiology, comorbidities, and consequences related to the different spectrum of muscle activities exerted in relation to the different circadian manifestations. Furthermore, less literature data are available on AB than on SB. The introduction of ecological momentary assessment (EMA) strategies has allowed for collecting valuable data on the frequency of the different activities reported by an individual in his/her natural environment. This strategy has been further improved with the recent use of smartphone technologies. Recent studies have described an average frequency of AB behaviors, within the range of 23–40% for otherwise healthy young adults. An association between AB and some psychological traits has emerged, and the findings have indicated that patients with musculoskeletal symptoms (e.g., temporomandibular joint and/or muscle pain, muscle stiffness, and fatigue) report higher AB frequencies. Preliminary data suggest that muscle bracing and teeth contact are the most commonly reported behaviors, while teeth clenching is much less frequently reported than commonly believed previously. Report of teeth grinding during wakefulness is almost absent. This paper has critically reviewed the currently available approaches for the assessment of AB. In addition, some future perspectives and suggestions for further research have been provided.

The prevalence of awake bruxism (AB) has been reported as being 30%, with sleep bruxism (SB) at 9–15%. Most studies have focused on SB, emphasizing the importance of AB research. For epidemiological evaluations of AB, a smartphone application based on ecological momentary assessment (EMA) was introduced. The aims of this multi-center study were: (1) to investigate how well lay subjects comprehend the AB terminology used in the smartphone application, and (2) to find out whether professional instruction improved their comprehension. The study population consisted of lay subjects from Italy, Portugal, and Finland comprising 307 individuals (156 men, 151 women; 18–86 years). Subjects first completed a five-item questionnaire about the meanings of the five AB terms used in the smartphone application. Each question offered four answer options, with one being correct. Immediately afterwards, the meanings of the terms were instructed. Lastly, the subjects were re-tested with the same questionnaire. In Finland and Italy, the re-tested correct answer scores for the single terms were at 89–97% per term. Improved comprehension was seen across sex, education, and age groups. In the Portuguese data, no improvement was found. Significant differences were found between countries in the improved scores for all terms that were correct following the instruction (Finland, 16.3% to 72.1%; Italy, 32.3% to 83.8%; Portugal, 23.1% to 33.7%) (p < 0.001). In conclusion, standardized instruction on AB terminology prior to EMA is recommended to improve the reliability of collected data.

Objectives: This study aimed to assess frequency and multiple-night variability of sleep bruxism (SB) as well as sleep-time masticatory muscle activities (sMMA) in the home environment in healthy young adults using a portable device that provides electrocardiographic (ECG) and surface electromyographic (EMG) recordings from the masticatory muscles. Methods: The study was performed on 27 subjects (11 males, 16 females, mean age 28.3 &plusmn, 1.7 years) selected from a sample of healthy young students. Evaluation was carried out for four nights to record data on masticatory muscle activities using a compact portable device that previously showed an excellent agreement with polysomnography (PSG) for the detection of SB events. The number of SB episodes per sleep hour (bruxism index), and the number of tonic, phasic and mixed sMMA events per hour were assessed. A descriptive evaluation of the frequency of each condition was performed on all individuals, and gender comparison was investigated. Results: Mean sleep duration over the four recording nights was 7 &plusmn, 1.3 h. The average SB index was 3.6 &plusmn, 1.2. Most of the sMMA were tonic (49.9%) and phasic (44.1%). An ANOVA test showed the absence of significant differences between the four nights. No significant gender differences were detected for the SB index, phasic or tonic contractions, conversely, gender differences were detected for mixed sMMA events (p &lt, 0.05). Conclusion: This investigation supports the concept that sMMA events are quite frequent in healthy adults. Differences over the four-night recording span were not significant. These data could be compared to subjects with underlying conditions that may lead to an additive bruxism activity and possible clinical consequences.

Bruxism is a common condition that clinicians come across in both adult and children. Prevalence rates in adults range from 22% to 30% for awake bruxism (AB) and from 8% to 16% for sleep bruxism (SB), while in children they raise up to 40% for SB. Currently, bruxism is considered an ‘umbrella term’ for different jaw muscle activities, occurring during sleep and/or wakefulness. They have a different aetiology, but there is agreement on their central, not peripheral, origin. In otherwise healthy individuals, bruxism can be considered a muscle behaviour, which can be harmless or represent a risk and/or protective factor for clinical consequences, rather than being a disorder per se. Nonetheless, given the merging knowledge on the interaction with several associated factors and concurrent conditions, bruxism should be investigated for being a possible sign of an underlying primary condition. Consequently, treatment should be directed to the management of the possible clinical consequences and/or to the underlying primary conditions. It is generally based on the conservative strategies. The present manuscript summarises the available knowledge on bruxism aetiology, assessment and management for both SB and AB in adults and children, with focus on the future directions to implement the clinical relevance of bruxism researches. Clinical relevance: A narrative overview summarising such a quickly evolving topic as bruxism may be useful to help clinicians understanding the complex relationship among bruxism, the possible underlying primary conditions, and the possible clinical consequences.

A smartphone-based ecological momentary assessment (EMA) strategy to collect real time data on awake bruxism (AB) has been recently introduced. The aim of this study was to assess the compliance with its use over 1 week in a sample of healthy young adults. Sixty (N = 60) healthy young adults (mean age 24.2 ± 4.1 years) used a dedicated smartphone application that sent 20 alerts at random times throughout the day. Upon alert receipt, the subjects had to report in real time their condition among five possible options: relaxed jaw muscles, teeth contact, teeth clenching, teeth grinding, and mandible bracing. Compliance rate with the app was assessed at the individual and group level in terms of percentage of answered alerts as well as number of days that were needed to reach the targeted observation period of 7 days with a compliance of at least 60%. The mean compliance recorded with the smartphone application was 67.8% of the total alerts. On average, 9.8 ± 3.2 days (range 7–19) have been necessary to achieve the targeted goal of 7 days with a minimum of 60% alerts/day. No gender differences were detected in any compliance data. Response rate was not different during weekdays or weekends. This investigation is the first attempt to assess individual compliance with EMA for reporting awake bruxism. Results suggest that a smartphone-based strategy can have interesting potential. The compliance rate reported in this study will serve as a comparison standpoint for future investigations. Based on the recent multidisciplinary focus on the study of awake bruxism, EMA has emerged as a potential approach for use in the clinical and research settings. This investigation suggests that compliance with such strategy is good, thus making it worthy of adoption for the assessment of AB and its clinical implications.

Background To assess the efficacy of a multibracket appliance-Straight-wire Mirabella (SWM) prescription-in terms of achieving the ideal first-, second- and third-order values proposed by Andrews. Material and methods A total sample of 46 Caucasian subjects was divided into two groups: 23 with class I malocclusion (Group 1), and 23 with class II malocclusion (Group 2). The treatment protocol involved fixed multibracket appliances-SWM prescription-for both groups, with the addition of class II elastics for Group 2. Values for ΔU1-PP, ΔIMPA, in-out, tip and torque were measured on digital scans, and the results obtained were compared with the ideal values proposed by Andrews. Results Statistically significant differences were revealed between the entire sample and Andrews' values for: in-out on upper lateral incisors and upper canines; tip on the upper first premolars, upper second premolars, upper first molars and upper canines; and torque on the lower central incisors, lower lateral incisors, lower canines and lower first premolars. However, comparison of Groups 1 and 2 revealed statistically significant differences only at the lower lateral incisors. The use of class II elastics influenced ΔIMPA values, but not ΔU1-PP. Conclusions The efficacy of the multibracket appliance-SWM prescription-in expressing first- second- and, to a lesser extent, third-order information was demonstrated in both class I and class II malocclusions. Class II elastics only influenced the third-order expression on the lower lateral incisors and the ΔIMPA. Key words:Straight wire fixed appliances, prescription efficacy, Class I malocclusions, Class II malocclusions.

Objective The twofold aim of the present investigation was to: 1. evaluate the degree of mid-palatal suture (MPS) maturation via CBCT in relation to patient age, and 2. to determine whether there was a correlation between quantitative (i.e., suture density) and qualitative (i.e., suture morphology) analysis. Materials and methods The stage of mid-palatal suture maturation and suture density ratio were assessed for 160 subjects on CBCTs using five qualitative stages proposed by Angelieri with the addition of three additional stages (i.e., B/C, C/D and D/E) and quantitative grey density scores of Grunheid MPS1,2,3,4 with the addition of parasutural bone and soft palate. The repeatability of both methods was evaluated using Cohen's K.The relationship between midpalatal suture maturation and age was assessed using ANOVA and Classification and Regression Trees (CART) analysis and tabulation and a χ2 test for quantitative and qualitative analysis respectively. Statistical significance was assessed using a 5% threshold. Results The final sample included 160 CBCTs (80 male,80 female; mean age 23.2±13.5). Both methods were found to be correlated and highly repeatable. In addiction they showed an age-related correlation in MPS morphology. Conclusion The mid-palatal suture density ratio and the stage of mid-palatal suture maturation has the potential to become useful in clinical practice. In fact, despite the correlation between MPS maturation stage and age, the latter parameter cannot be used as a clinical discriminator due to the great variability between subjects. It is therefore advisable to assess each patient individually on CBCT scans in order to determine treatment choices.

Summary Objective The purpose of this study was to evaluate the biomechanical properties of miniscrews of 5 different lengths, 2 different diameters, and different combinations of insertion used for palatal skeletal anchorage. Materials and methods Twenty-four different combinations of a total of 120 miniscrews of two different diameters (2.0 mm and 2.3 mm) and five different lengths (9 mm, 11 mm, 13 mm and 15 mm) were tested at different angles of insertion (90° and 45°) and distances from a synthetic bone block (3 mm, 5 mm, 7 mm). Samples were fixed in an Instron Universal Testing Machine and a load was applied in single cantilever mode to the neck of each miniscrew. The stiffness and maximum load before permanent deformation were recorded. Model-based recursive partitioning testing (CART) was used to evaluate differences between groups. Results Significantly higher forces were necessary to deform miniscrews of diameter 2.3 mm than those of 2.0 mm, those inserted at an angle of 45° with respect to 90°, and at smaller distances between the miniscrew neck and block; in addition, the maximum load and stiffness increased with increasing screw length. Conclusion This in vitro experimental study showed strong correlations between deformation load and miniscrew geometry, insertion angle and distance from the synthetic block, results that should be considered when planning miniscrew insertion in order to reduce the risk of unwanted fracture.

Objective: To investigate the association between volumetric measurements of craniofacial morphology and temporomandibular disorders (TMDs). Methods: Computerized tomography (CT) scans of 20 individuals aged 18 to 40 with (TMD group) or without TMJ pain (control group) were gathered based on a case-control design. Three-dimensional reconstructions were performed to evaluate the gonial angle, condylar volume, and the distance between the posterior edge of the condyle and the sigmoid notch. Results: The gonial angle was significantly larger (8% difference) in the TMD group with respect to controls, whereas the condylar volume was significantly higher in the control group (15.2% difference). No significant difference was found in the linear distance. Conclusion: There is an association between the presence of TMJ pain and some features of craniofacial morphology. Individuals with TMJ pain have a lower condylar volume and a tendency towards hyperdivergent growth.

This case report describes the use of a miniscrew-assisted rapid palatal expander and aligners to correct bilateral cross-bite and crowding in an adult patient with a Class III skeletal pattern. A digitally designed surgical guide was three-dimensionally printed and used to accurately insert four miniscrews into the palate; these were employed to anchor a novel miniscrew-assisted rapid palatal expander appliance without any dental anchorage. Cone-beam computed tomograms before and after miniscrew-assisted rapid palatal expander treatment demonstrated the orthopedic expansion of the maxilla without dental tipping. The patient was then fitted with aligners to correct crowding and malocclusion. This case report demonstrates the successful treatment of an adult patient with a narrow maxilla and bilateral cross-bite using a nonsurgical, conservative treatment.

Demographic and social changes in the last decades have resulted in improvements in health and longevity. The survival of elderly people has improved significantly and thus centenarians are becoming the fastest growing population group. Environmental, genetic, and accidental factors have influenced the human life span. Researchers have gained substantial evidence that advanced glycation end products may play an important role in the processes of physiological aging. The aim of the present study was to investigate any differences in the frequencies of −374T/A polymorphism in subjects aged &gt, 90 years and in middle-aged individuals. We observed association between the A allele and genotype homozygous for this allele (AA) with a longer life expectancy in the male population. In particular, there was a prevalence of AA genotype and A allele in long-living subjects and a prevalence of the allele T in middle-aged subjects, indicating a possible protective role of the allele A to aging. In conclusion, our results support the hypothesis that longevity is the result of a good functioning of the immune system and a presumable hyper-expression of variants of anti-inflammatory genes of immunity. The differences in the genetic regulation of inflammatory processes may influence the presence of age-related disorders.

Heart failure (HF) is a multifactorial disorder in which clinical, environmental and genetic components take part. For this reason it is possible that common gene variants could affect development, progression and response to pharmacological therapy. In recent years the role of AGEs in the pathogenesis of cardiovascular diseases has become recognized but little is known about the role of the AGE-RAGE system in heart failure. The aim of the present study was to identify possible relationship between -374 T/A RAGE gene polymorphism with heart failure. The population in this study consists of 386 subjects with HF, selected according to the presence of depressed Left Ventricular Ejection Fraction (LVEF)

Subclinical hypothyroidism and hyperthyroidism have been recognized as clinical entities with negative effects on the cardiovascular system. Moreover, the effect of treated thyroid dysfunction on parameters associated with the cardiovascular control system has been poorly investigated. In the present study we analyzed time-domain heart rate variability in coronary artery disease (CAD) patients with known thyroid diseases. Twenty-four hour ECG monitoring was performed in 344 patients with coronary artery disease (174 with thyroid dysfunction and 170 without thyroid dysfunction used as a control group), using a 3-channel tape recorder. Time domain parameters of heart rate variability (HRV) were definitely lower both in patients with subclinical hypothyroidism and subclinical hyperthyroidism than in the control group, with statistically significant differences in SDNN, RMSSD, TINN, and mean RR for both subgroups. Furthermore, patients on L-thyroxine treatment and restored euthyroidism had generally higher HRV values than patients with subclinical hypothyroidism, nevertheless SDNN, RMSSD, SDNN index, TINN, and mean RR were significantly lower when compared to those of the control group. Significant differences in HRV were also found between hyperthyroid patients under treatment and control group subjects with respect to RMSSD, TINN, and mean RR values. In conclusion, patients with cardiac disease and known thyroid disease, even when the disease is in the subclinical range or despite treatment, should be regarded as patients at additional risk conveyed by thyroid hormone disturbances.

Objective: Cardiovascular Disease (CVD) is the leading cause of death and disability worldwide. sDyregulation of the autonomic nervous system associated with various pathological conditions often occurs in presence of cardiovascular risk factors. Heart Rate Variability (HRV) may be used to assess autonomic imbalances. The aim of our study is to evaluate the correlation between HRV and the main cardiovascular risk factors in subject who underwent digital ambulatory 24 hours Holter ECG monitoring for clinical investigations. Methods: We evaluated time domain parameters of HRV by Holter ECG monitoring in a large population categorized based on the presence or absence of the major cardiovascular risk factors. Results: We found significant differences in time domain parameters of HRV in patients with and without common risk factor for CVD such as diabetes, family history for Coronary Artery Disease and dyslipidemia. We also analyzed our study population based on age and we found a positive correlation with the standard deviation of all NN intervals (SDNN), square root of the mean of the sum of the square of the differences between adjacent NN intervals (RMSSD), mean R-R intervals and by the number of adjacent NN intervals differing by more than 50 ms divided by the total number of all NN intervals (pNN50) and an inverse correlation for the others parameters. Conclusion: Non-modifiable risk factors (age, gender, family history) along with dyslipidemia and diabetes, are related to a change in HRV, while modifiable risk factors (smoking, hypertension, overweight, hyperhomocysteinemia) showed no correlation. This would seem to indicate that the genetic components more than lifestyle habits and behavior act on the nervous control of the heart. Our study shows the possibility to find interesting clinical-prognostic data, analyzing simple parameters obtained from instrumental methods of investigation performed for other clinical reasons.

Receptor for Advanced Glycation End-products (RAGE) is a multi-ligand receptor ubiquitous present on epithelial, neuronal, vascular and inflammatory cells, usually expressed at low levels in homeostasis and to increased degrees at sites of stress or injury. The aim of the present study was to evaluate sRAGE plasma levels in patients with Acute Coronary Syndrome (ACS) and to assess its diagnostic efficacy in identification of patients with acute events. Plasma levels of sRAGE were determined in 860 patients with Coronary Artery Disease (CAD): 530 patients presented stable angina and 330 were observed during acute ischemic event (147 with unstable angina and 183 with myocardial infarction). sRAGE plasma levels were significantly lower in patients with ACS than in patients with stable angina: [median 584 pg/mL (IQR: 266–851 pg/mL) in MI patients, median 769 pg/mL (IQR: 394–987 pg/mL) in patients with unstable angina, median 834 pg/mL (IQR 630–1005 pg/mL) in patients with stable angina;P<0.001]. sRAGE levels did not differ among ACS patients stratified by the extent of coronary artery disease. In conclusion, this study confirm the role of sRAGE in activation and progression of inflammatory process and suggests the possibility that sRAGE can be considered an indicator of destabilization of vulnerable plaque.