Acute coronary syndromes without coronary plaque rupture
Siddak S Kanwar1, Gregg W Stone2, Mandeep Singh3
1Icahn School of Medicine at Mount Sinai, 1190 Fifth Avenue, New York, New York 10029, USA.
Nature Reviews. Cardiology
|February 26, 2016
Summary
New plaque imaging reveals that acute coronary syndrome (ACS) can stem from plaques with intact fibrous caps (IFC), not just ruptured ones. This offers a new path for personalized ACS treatment strategies.
Area of Science:
- Cardiology
- Medical Imaging
- Pathology
Background:
- Acute coronary syndrome (ACS) is often linked to ruptured plaques.
- Plaque morphology, particularly intact fibrous cap (IFC) plaques, plays a significant role in ACS events.
- Current clinical practice predominantly associates ACS with thin-cap fibroatheromas.
Purpose of the Study:
- To review recent advances in understanding plaque morphology in ACS, focusing on IFC.
- To analyze contemporary intravascular imaging data related to IFC in ACS.
- To explore the potential of plaque imaging for guiding individualized ACS management.
Main Methods:
- Review of contemporary data from intravascular imaging studies.
- Analysis of plaque morphology findings in patients with ACS.
- Synthesis of current understanding of IFC's role in ACS pathogenesis.
Main Results:
- A substantial proportion of ACS events originate from plaques with an intact fibrous cap (IFC).
- Intravascular imaging provides detailed insights into the morphology of these IFC plaques.
- Clinicians' focus has predominantly been on plaque rupture, potentially overlooking IFC contributions.
Conclusions:
- Plaque imaging offers new opportunities for diagnosing and managing ACS.
- Understanding ACS with IFC through advanced imaging can lead to more personalized treatment.
- Intravascular imaging may guide more effective management strategies for ACS patients.
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