title: Microvascular dysfunction in the spectrum of coronary instability.
abstract: The term "coronary instability" commonly refers to the sequence of events that lead from plaque erosion or rupture to the occurrence of acute coronary syndromes (ACS). However, evidence indicates that coronary microvascular dysfunction plays a relevant pathophysiologic and prognostic role in the setting of ACS, both in ST-segment elevation myocardial infarction and in non-ST-segment elevation ACS. Our group have recently demonstrated that Tako-Tsubo syndrome, which clinically mimics ACS, is sustained by a common pathophysiologic mechanism represented by reversible coronary microvascular dysfunction. Given this evidence, we propose a reappraisal of the concept of coronary instability, extending this notion from the dramatic event represented by plaque erosion or rupture to a more diffuse process that can acutely affect each segment of the coronary circulation.
authors.affiliation: Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Alberto Ranieri
authors.initials: AR
authors.lastname: De Caterina
authors.forename: Leonarda
authors.initials: L
authors.lastname: Galiuto
authors.forename: Elisa
authors.initials: E
authors.lastname: Fedele
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
mesh_terms: D054058:Acute Coronary Syndrome / Q000503:physiopathology*; D003324:Coronary Artery Disease / Q000503:physiopathology*; D003326:Coronary Circulation / Q000502:physiology*; D004452:Echocardiography; D004730:Endothelium, Vascular / Q000503:physiopathology; D006801:Humans; D007249:Inflammation / Q000503:physiopathology; D008833:Microcirculation / Q000502:physiology*; D009203:Myocardial Infarction / Q000503:physiopathology; D054549:Takotsubo Cardiomyopathy / Q000503:physiopathology