Do plaques rapidly progress prior to myocardial infarction? The interplay between plaque vulnerability and...

Area of Science:

• Cardiovascular Medicine
• Pathology
• Interventional Cardiology

Background:

• A common misconception suggests acute coronary events arise from mildly stenotic plaques.
• Previous studies measured stenosis long before events, leading to this misperception.
• Recent evidence indicates culprit plaques are severely stenotic at the time of myocardial infarction.

Purpose of the Study:

• To challenge the notion that mild plaques cause most acute coronary events.
• To highlight the role of rapid plaque progression in acute coronary syndromes.
• To identify vulnerable plaques prone to adverse outcomes.

Main Methods:

• Analysis of angiographic studies within 3 months of myocardial infarction.
• Review of postmortem pathological observations.
• Examination of intravascular and noninvasive imaging studies.

Main Results:

• Culprit plaques in acute myocardial infarction are severely stenotic.
• Rapid lesion progression precedes most acute coronary syndromes.
• Vulnerable plaques exhibit larger volume, necrotic core, and positive remodeling.

Conclusions:

• Acute coronary events are linked to severely stenotic and vulnerable plaques.
• Rapid plaque progression is a critical factor in identifying high-risk lesions.
• Monitoring plaque progression may improve prediction of adverse cardiovascular events.