Pathophysiology of acute coronary syndrome
Carlos G Santos-Gallego1, Belen Picatoste, Juan José Badimón
1Atherothrombosis Research Unit, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1030, New York, NY, 10029, USA.
Insights
Atherosclerotic disease remains a leading cause of death. Recent research redefines acute coronary syndrome (ACS) as an inflammatory condition, moving beyond lipid deposition and plaque rupture to include erosion and calcified nodules.
Area of Science:
- Cardiovascular Medicine
- Pathophysiology
- Inflammation Biology
Background:
- Atherosclerotic disease is the primary cause of mortality globally.
- Current treatments for atherosclerotic disease require enhancement.
- A deeper understanding of the disease's molecular mechanisms and pathophysiology is crucial.
Purpose of the Study:
- To review recent advancements in understanding acute coronary syndrome (ACS).
- To highlight the shift in perspective from a lipid-centric to an inflammatory view of ACS.
- To incorporate novel concepts like plaque erosion and calcified nodules in ACS etiology.
Main Methods:
- Literature review of recent research (last decade) on atherosclerotic disease and ACS.
- Synthesis of evolving concepts regarding ACS pathophysiology.
- Analysis of new definitions and contributing factors to ACS.
Main Results:
- Acute coronary syndrome (ACS) is increasingly recognized as an inflammatory disease, not solely due to lipid deposition.
- Plaque rupture is no longer the sole cause; plaque erosion and calcified nodules are identified as key mechanisms.
- The role of thrombus has been re-evaluated, with concepts of healed plaques and thrombus-induced progression emerging.
Conclusions:
- Recent research has significantly reshaped the understanding of ACS.
- Viewing ACS as an inflammatory disease offers new therapeutic targets.
- Novel concepts provide a more comprehensive framework for studying and treating ACS.
Abstract:
Despite improvements in interventional and pharmacological therapy for atherosclerotic disease, it is still the leading cause of death in the developed world. Hence, there is a need for further development of more effective therapeutic approaches. This requires better understanding of the molecular mechanisms and pathophysiology of the disease. Recent research in the last decade has changed our view of acute coronary syndrome (ACS): from a mere lipid deposition to an inflammatory disease; from ACS exclusively due to plaque rupture to the novel definitions of plaque erosion or calcified nodule; from the notion of a superimposed thrombus with necessary lethal consequences to the concept of healed plaques and thrombus contributing to plaque progression. In the hope of improving our understanding of ACS, all these recently discovered concepts are reviewed in this article.
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