title: Advances in mechanisms, imaging and management of the unstable plaque.
abstract: 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 "vulnerable plaques" 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 "holy grail". 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.
authors: Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
authors: Giampaolo
authors: G
authors: Niccoli
authors: Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
authors: Giovanna
authors: G
authors: Liuzzo
authors: Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
authors: Rocco A
authors: RA
authors: Montone
authors: Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy. Electronic address: filippo.crea@rm.unicatt.it.
authors: Filippo
authors: F
authors: Crea
mesh_terms: D054058:Acute Coronary Syndrome / Q000145:classification / Q000209:etiology / Q000473:pathology; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology / Q000473:pathology; D003326:Coronary Circulation; D003329:Coronary Vasospasm / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control; D003952:Diagnostic Imaging; D003935:Diagnostic Techniques, Cardiovascular; D020869:Gene Expression Profiling; D006801:Humans; D007249:Inflammation; D008264:Macrophages / Q000473:pathology; D009000:Monocytes / Q000473:pathology; D064847:Multimodal Imaging; D058226:Plaque, Atherosclerotic / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology / Q000473:pathology; D011379:Prognosis; D012422:Rupture, Spontaneous; D016176:T-Lymphocyte Subsets / Q000276:immunology / Q000473:pathology; D061205:Vascular Calcification / Q000175:diagnosis / Q000209:etiology / Q000473:pathology; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D014665:Vasodilator Agents
keywords: Acute coronary syndromes; Imaging; Unstable plaque