Coronary artery disease: Pathogenesis and acute coronary syndromes

Stephen G. Worthley, Julio I. Osende, Gérard Helft, Juan J. Badimon, Valentin Fuster

Research output: Contribution to journalArticlepeer-review

58 Scopus citations

Abstract

Atherosclerotic diseases and their thrombotic complications remain the leading causes of mortality and morbidity in Western society. In the United States, cardiovascular disease is responsible for one in every 2.4 (41.4%) deaths and is the leading single cause of mortality. Furthermore, the presence of atherosclerotic disease (defined as thickening of the arterial wall through the accumulation of lipids, macrophages, T-lymphocytes, smooth muscle cells, extracellular matrix, calcium and necrotic debris) is more prevalent, but by itself rarely fatal. The crucial, final common process for the conversion of a nonocclusive, often clinically silent atherosclerotic lesion to a potentially fatal condition is often plaque disruption. The mortality associated with atherosclerotic disease relates to the acute coronary syndromes, including acute myocardial infarction, unstable angina pectoris and sudden cardiac death. Substantial clinical, experimental and postmortem evidence demonstrates the central role that a superimposed acute thrombosis on a disrupted atherosclerotic plaque plays in the onset of acute coronary syndromes. Therefore, therapeutic approaches to date have focused on reducing such thrombotic complications of atherosclerotic plaques (i.e., antiplatelet, anticoagulant and thrombolytic therapies) to reduce the resulting morbidity and mortality. In this review, we will focus on the current theories of atherogenesis and how they impact on our understanding of acute coronary syndromes.

Original languageEnglish
Pages (from-to)167-181
Number of pages15
JournalMount Sinai Journal of Medicine
Volume68
Issue number3
StatePublished - May 2001

Keywords

  • Acute coronary syndrome
  • Atherogenesis
  • Atherosclerosis
  • Collateral circulation
  • Hemodynamics
  • Plaque disruption
  • Plaque formation
  • Platelet aggregation
  • Platelets
  • Q-wave myocardial infarction
  • Rheology
  • Risk factors
  • Thrombogenicity
  • Thrombosis

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