title: Acute coronary syndromes without coronary plaque rupture.
abstract: The latest advances in plaque imaging have provided clinicians with opportunities to treat acute coronary syndrome (ACS) and provide individualized treatment recommendations based not only on clinical manifestations, angiographic characteristics, and biomarker data, but also on the findings of plaque morphology. Although a substantial proportion of ACS events originate from plaques with an intact fibrous cap (IFC), clinicians predominantly equate ACS with plaque rupture arising from thin-cap fibroatheromas. In this Review, we discuss the recent advances in our understanding of plaque morphology in ACS with IFC, reviewing contemporary data from intravascular imaging. We also explore whether use of such imaging might provide a roadmap for more effective management of patients with ACS.
authors.affiliation: Icahn School of Medicine at Mount Sinai, 1190 Fifth Avenue, New York, New York 10029, USA.
authors.forename: Siddak S
authors.initials: SS
authors.lastname: Kanwar
authors.affiliation: Columbia University Medical Center and the Cardiovascular Research Foundation, 161 Washington Avenue, New York, New York 10032, USA.
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.affiliation: Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA.
authors.forename: Mandeep
authors.initials: M
authors.lastname: Singh
authors.affiliation: CVPath Institute, 19 Firstfield Road, Gaithersburg, Maryland 20878, USA.
authors.forename: Renu
authors.initials: R
authors.lastname: Virmani
authors.affiliation: Icahn School of Medicine at Mount Sinai, 1190 Fifth Avenue, New York, New York 10029, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Olin
authors.affiliation: Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama Prefecture 641-8509, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Akasaka
authors.affiliation: Icahn School of Medicine at Mount Sinai, 1190 Fifth Avenue, New York, New York 10029, USA.
authors.forename: Jagat
authors.initials: J
authors.lastname: Narula
mesh_terms: D054058:Acute Coronary Syndrome / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D000368:Aged; D001706:Biopsy; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications* / Q000473:pathology / Q000628:therapy; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology*; D003952:Diagnostic Imaging / Q000379:methods; D005355:Fibrosis; D006801:Humans; D008297:Male; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D012422:Rupture, Spontaneous; D041623:Tomography, Optical Coherence; D018084:Ultrasonography, Interventional