Key Points
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Disruption of the fibrous cap on vulnerable atherosclerotic coronary plaques leads to exposure of the thrombogenic lipid core to the bloodstream, and is responsible for two-thirds of all coronary events
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In approximately one-third of patients with acute coronary syndrome (ACS), the thrombus develops after intimal erosion without fibrous cap rupture
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Advances in plaque imaging have allowed clinicians to treat patients with ACS based not only on clinical manifestations, angiographic characteristics, and biomarker data, but also on plaque morphology
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The use of optical coherence tomography without angiographically obvious plaque rupture can assist in identification and characterization of the culprit lesion plaque morphology
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Conservative pharmacologic treatment without revascularization might be appropriate in some patients with an intact fibrous cap
Abstract
The latest advances in plaque imaging have provided clinicians with opportunities to treat acute coronary syndrome (ACS) and provide individualized treatment recommendations based not only on clinical manifestations, angiographic characteristics, and biomarker data, but also on the findings of plaque morphology. Although a substantial proportion of ACS events originate from plaques with an intact fibrous cap (IFC), clinicians predominantly equate ACS with plaque rupture arising from thin-cap fibroatheromas. In this Review, we discuss the recent advances in our understanding of plaque morphology in ACS with IFC, reviewing contemporary data from intravascular imaging. We also explore whether use of such imaging might provide a roadmap for more effective management of patients with ACS.
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J.N. and S.S.K. substantially contributed to discussion of content, wrote, and reviewed and edited the manuscript before submission. G.W.S., M.S., R.V., and T.A. substantially contributed to discussion of content, and reviewed and edited the manuscript before submission.
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Kanwar, S., Stone, G., Singh, M. et al. Acute coronary syndromes without coronary plaque rupture. Nat Rev Cardiol 13, 257–265 (2016). https://doi.org/10.1038/nrcardio.2016.19
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DOI: https://doi.org/10.1038/nrcardio.2016.19
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