Vulnerable plaques and patients: state-of-the-art

Area of Science:

• Cardiology
• Vascular Biology
• Medical Imaging

Background:

• Coronary heart disease (CHD) is the primary global cause of mortality.
• Sudden cardiac death often occurs without warning symptoms, even from non-obstructive plaques.
• The concept of 'vulnerable plaque' has evolved to 'cardiovascular vulnerability' in patients.

Purpose of the Study:

• To critically appraise current evidence, developments, and future directions in detecting, preventing, and treating high-risk plaques in vulnerable patients.
• To highlight the shift from lesion-specific vulnerability to patient-specific cardiovascular vulnerability.
• To discuss the role of advanced imaging in guiding treatment strategies.

Main Methods:

• Review of recent advances in understanding plaque pathogenesis and pathophysiology.
• Analysis of current pharmacotherapy and preventive strategies for CHD.
• Evaluation of emerging coronary plaque imaging technologies and their clinical relevance.

Main Results:

• Acute coronary syndromes (ACS) result from various mechanisms including plaque rupture, erosion (25-60% of ACS), calcified nodules, and functional coronary alterations.
• Despite optimal medical treatment, cardiovascular events persist.
• Current imaging precursors for culprit plaques lack sufficient positive predictive value for clinical use.

Conclusions:

• Improving coronary plaque imaging is crucial for tailoring pharmacotherapy intensity and allocating advanced treatments.
• Interdisciplinary research is essential to enhance cardiovascular prognosis through systemic and local diagnostics and therapies.
• Future efforts should focus on integrated approaches for the detection, prevention, and treatment of high-risk plaques in vulnerable individuals.