Advances in mechanisms, imaging and management of the unstable plaque

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• 作者：Giampaolo Niccoli ; Giovanna Liuzzo ; Rocco A. Montone ; Filippo Crea ; ^{filippo.crea@rm.unicatt.it" class="auth_mail}
• 关键词：Unstable plaque ; Acute coronary syndromes ; Imaging
• 刊名：Atherosclerosis
• 出版年：April, 2014
• 年：2014
• 卷：233
• 期：2
• 页码：467-477
• 全文大小：1342 K

文摘

Post-mortem observations demonstrated that plaque fissure was the final event leading to coronary thrombosis and occlusion in about two-thirds of cases of sudden coronary death. Plaques prone to fissure have, therefore, been defined 鈥渧ulnerable plaques鈥?and are identified by specific anatomic features including thin inflamed fibrous cap, large lipidic core and positive remodeling. Accordingly, elegant imaging modalities have been developed in order to identify this 鈥渉oly grail鈥? However, the results of prognostic studies based on the identification of vulnerable plaques have not been encouraging because of the low positive predictive value for major cardiovascular events. This observation is not surprising as the pathogenesis of acute coronary syndromes is complex and multifactorial. In this review we propose a pathogenetic classification of acute coronary syndromes in the attempt to identify homogeneous groups of patients with a common mechanism of coronary instability which can be identified by using specific biomarkers and imaging techniques, and become a specific therapeutic target.