New Concepts on the Pathophysiology of Acute Coronary Syndrome

Yuan, Deqiang; Chu, Jiapeng; Qian, Jun; Lin, Hui; Zhu, Guoqi; Chen, Fei; Liu, Xuebo

doi:10.31083/j.rcm2404112

Cited by 9 publications

(7 citation statements)

References 83 publications

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“…Different histological and structural characteristics confer a higher risk of rupture to plaques, such as thin fibrous caps (<65 μm), large lipid-rich cores, increased macrophage density, and neovascularization. Additionally, plaque susceptibility is heightened by the presence of intraplaque hemorrhage and calcification [8].…”

Section: Plaque Rupturementioning

confidence: 99%

“…Shear stress and cyclic tension exerted on the plaque thin it and facilitate rupture. Chronic inflammation on the plaque induces the release of proteolytic enzymes, mainly matrix metalloproteinases (MMP), which degrade extracellular matrix components [8].…”

Section: Plaque Rupturementioning

confidence: 99%

“…In addition to plaque rupture, plaque erosion, and calcified nodules, other non-atherosclerotic causes of ACS have been identified, including coronary vasospasm, spontaneous coronary artery dissection, stress-induced cardiomyopathy, and embolism of the coronary artery from thrombi originating elsewhere in the body, causing obstruction [8].…”

Section: Calcified Nodulementioning

confidence: 99%

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Acute coronary syndrome: Definition, pathophysiology, diagnosis, and management

Erick Alexander Cabrera Estrada,

Epitafio Rafael Mestre Sequeda,

Jairo Enrique Barcinilla Barros

et al. 2024

World J. Adv. Res. Rev.

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Acute coronary syndrome (ACS) represents the most severe form of presentation of ischemic heart disease and imposes a significant burden on morbidity and mortality worldwide, particularly in low- and middle-income countries. Within the clinical spectrum of coronary syndrome are ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina. Although primarily caused by atherosclerotic plaque thrombosis or non-atherosclerotic causes, its pathophysiological mechanisms are not fully understood. Currently, the main mechanisms include plaque rupture, plaque erosion, calcified nodules, and non-atherosclerotic causes such as coronary vasospasm. For ACS diagnosis, the electrocardiogram (ECG) is recommended primarily, along with high-sensitivity cardiac troponins (hs-cTn), following recommended algorithms to determine the testing interval. Non-invasive diagnostic tools such as echocardiography, computed tomography (CT), and cardiac magnetic resonance (CMR) are also available. These are mainly indicated in patients with inconclusive ECG and hs-cTn results and for establishing differential diagnoses. The management of ACS should be multidisciplinary, encompassing pharmacological, invasive techniques, and non-pharmacological approaches. It should be individualized considering each patient's characteristics.

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Section: Plaque Rupturementioning

confidence: 99%

Section: Plaque Rupturementioning

confidence: 99%

Section: Calcified Nodulementioning

confidence: 99%

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Acute coronary syndrome: Definition, pathophysiology, diagnosis, and management

Erick Alexander Cabrera Estrada,

Epitafio Rafael Mestre Sequeda,

Jairo Enrique Barcinilla Barros

et al. 2024

World J. Adv. Res. Rev.

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“…For an accurate ACS diagnosis and successful therapy, it is crucial to comprehend the intricate pathophysiology. 7,8,13,15 Aetherosclerosis and Plaque Rupture: Nearly all acute myocardial infarctions have thrombosis on a responsible coronary atherosclerotic plaque as their underlying cause. An increased risk of future thrombosis is indicated by vulnerable plaques, which include a big lipid core, a high macrophage density, a low smooth muscle cell density in the plaque cap, a high tissue factor content, and a thin, disorganised collagen structure in the cap.…”

Section: Pathophysiologymentioning

confidence: 99%

A Comprehensive Review of Acute Coronary Syndrome

Khurshid,

Farooq,

Ayesha

et al. 2023

AIM

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A significant sign of coronary artery disease is the acute coronary syndrome (ACS). Angina pectoris, ST-elevation myocardial infarction, and non-ST-elevation myocardial infarction (NSTEMI) are just a few of the conditions that are grouped together under the general term “ACS.” The main cause of death worldwide is cardiovascular disease, which puts ACS under a heavy financial strain. Reduced blood flow to the heart, primarily as a result of plaque rupture and thrombus development, is a pathogenesis of ACS. Numerous risk factors, both modifiable (such as smoking, hypertension, diabetes, hypercholesterolemia, obesity, and inactivity) and non-modifiable (like age, gender, and inheritance), can lead to the development of ACS. Electrocardiography (ECG), clinical evaluation, history-taking, and cardiac biomarkers are all used in the diagnosis process. For the best management, prompt diagnosis and risk classification are essential. Reperfusion therapy, anti-anginal therapy, and renin-angiotensin blocking are a few of the suggested procedures in treatment techniques that aim to minimise myocardial ischemia and restore coronary blood flow. Long-term management also strongly depends on modifying one’s lifestyle, including giving up smoking, eating a healthy diet, getting regular exercise, and obtaining rehabilitation. Acute cardiac failure, ventricular septum or papillary muscle rupture, arrhythmias, recurrent angina, and other consequences of ACS are also highlighted in the paper. The prognosis varies depending on variables, including persistent myocardial injury and the existence of ventricular arrhythmias; an unfavourable prognosis is frequently related to arrhythmias and is associated with poor left ventricular function. . This article offers a thorough review of ACS and gives readers important information about its pathophysiology, risk factors, diagnosis, therapy, and prognosis.

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“…Besides providing accurate anatomic information regarding coronary arteries via a non-invasive route, it can reliably identify features of increased vulnerability in the coronary circulation. Various studies investigated the association between these features and different cardiovascular pathologies, such as acute coronary syndromes (ACSs), atrial fibrillation, or heart failure [2,3].…”

Section: Introductionmentioning

confidence: 99%

Coronary Computed Tomography Angiography-Derived Modified Duke Index Is Associated with Peri-Coronary Fat Attenuation Index and Predicts Severity of Coronary Inflammation

Halațiu,

Benedek,

Rodean

et al. 2024

Medicina

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Background and Objectives: The modified Duke index derived from coronary computed tomography angiography (CCTA) was designed to predict cardiovascular outcomes based on the severity of coronary stenosis. However, it does not take into consideration the presence or severity of peri‑coronary inflammation. The peri-coronary fat attenuation index (FAI) is a novel imaging marker determined by CCTA which reflects the degree of inflammation in the coronary tree in patients with coronary artery disease. To assess the association between the modified Duke index assessed by CCTA, cardiovascular risk factors, and peri-coronary inflammation in the coronary arteries of patients with coronary artery disease. Materials and Methods: One hundred seventy-two patients who underwent CCTA for typical angina were assigned into two groups based on the modified Duke index: group 1—patients with low index, ≤3 (n = 107), and group 2—patients with high index, >3 (n = 65). Demographic, clinical, and CCTA data were collected for all patients, and FAI analysis of coronary inflammation was performed. Results: Patients with increased values of the modified Duke index were significantly older compared to those with a low index (61.83 ± 9.89 vs. 64.78 ± 8.9; p = 0.002). No differences were found between the two groups in terms of gender distribution, hypertension, hypercholesterolemia, or smoking history (all p > 0.5). The FAI score was significantly higher in patients from group 2, who presented a significantly higher score of inflammation compared to the patients in group 1, especially at the level of the right coronary artery (FAI score, 20.85 ± 15.80 vs. 14.61 ± 16.66; p = 0.01 for the right coronary artery, 13.85 ± 8.04 vs. 10.91 ± 6.5; p = 0.01 for the circumflex artery, 13.26 ± 10.18 vs. 11.37 ± 8.84; p = 0.2 for the left anterior descending artery). CaRi-Heart® analysis identified a significantly higher risk of future events among patients with a high modified Duke index (34.84% ± 25.86% vs. 16.87% ± 15.80%; p < 0.0001). ROC analysis identified a cut-off value of 12.1% of the CaRi-Heart® risk score for predicting a high severity of coronary lesions, with an AUC of 0.69. Conclusions: The CT-derived modified Duke index correlates well with local perilesional inflammation as assessed using the FAI score at different levels of the coronary circulation.

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New Concepts on the Pathophysiology of Acute Coronary Syndrome

Cited by 9 publications

References 83 publications

Acute coronary syndrome: Definition, pathophysiology, diagnosis, and management

Acute coronary syndrome: Definition, pathophysiology, diagnosis, and management

A Comprehensive Review of Acute Coronary Syndrome

Coronary Computed Tomography Angiography-Derived Modified Duke Index Is Associated with Peri-Coronary Fat Attenuation Index and Predicts Severity of Coronary Inflammation

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