The 'Perfect Storm' and Acute Coronary Syndrome Onset: Do psychosocial factors play a role?

Matthew M. Burg, Donald Edmondson, Daichi Shimbo, Jonathan Shaffer, Ian M. Kronish, William Whang, Carmela Alcántara, Joseph E. Schwartz, Paul Muntner, Karina W. Davidson

Research output: Contribution to journalArticlepeer-review

35 Scopus citations


The revolution in cardiac care over the past two decades, characterized by emergent revascularization, drug eluting stents, anti-platelet medications, and advanced imaging has had little impact on overall ACS recurrence, or ACS prevention. The "Perfect Storm" refers to a confluence of events and processes, including atherosclerotic plaque, coronary flow dynamics, hemostatic and fibrinolytic function, metabolic and inflammatory conditions, neurohormonal dysregulation, and environmental events that give rise to, and result in an ACS event. In this article we illustrate the limits of the traditional main effect research model, giving a brief description of the current state of knowledge regarding the development of atherosclerotic plaque and the rupturing of these plaques that defines an ACS event. We then apply the Perfect Storm conceptualization to describe a program of research concerning a psychosocial vulnerability factor that contributes to increased risk of recurrent ACS and early mortality, and that has defied our efforts to identify underlying pathophysiology and successfully mount efforts to fully mitigate this risk.

Original languageEnglish
Pages (from-to)601-610
Number of pages10
JournalProgress in Cardiovascular Diseases
Issue number6
StatePublished - May 2013
Externally publishedYes


  • Acute coronary syndrome
  • Depression
  • Stress


Dive into the research topics of 'The 'Perfect Storm' and Acute Coronary Syndrome Onset: Do psychosocial factors play a role?'. Together they form a unique fingerprint.

Cite this