Current Toolset in Predicting Acute Coronary Thrombotic Events: The "Vulnerable Plaque" in a "Vulnerable Patient"...

Area of Science:

• Cardiology
• Medical Imaging
• Biomarkers

Background:

• Coronary artery disease (CAD) is a leading cause of death globally, despite treatment advances.
• Current invasive imaging and hemodynamic analyses offer insights into plaque vulnerability but lack high predictive value.
• The concept of a "vulnerable patient" is crucial for precipitating acute coronary events, alongside "vulnerable plaques".

Purpose of the Study:

• To review and critically appraise invasive and non-invasive imaging modalities for detecting high-risk plaques in CAD patients.
• To discuss challenges in the "vulnerable plaque" concept.
• To highlight the need for an interdisciplinary approach combining "vulnerable plaque" and "vulnerable patient" assessments.

Main Methods:

• Review of invasive coronary imaging techniques (e.g., hemodynamic force computation).
• Evaluation of non-invasive imaging advancements for plaque identification and population screening.
• Integration of risk stratification scores, biomarkers, immunology, and genetics.

Main Results:

• Invasive methods provide detailed plaque analysis but have limited predictive power alone.
• Non-invasive techniques are emerging for early detection and screening in asymptomatic individuals.
• A broader "vulnerable plaque and patient" strategy is essential for improved risk stratification.

Conclusions:

• A shift towards an interdisciplinary approach is necessary for effective CAD management.
• Combining "vulnerable plaque" detection with "vulnerable patient" assessment improves risk prediction.
• Future strategies should integrate diverse modalities for comprehensive patient evaluation.