What is the role of vulnerable plaque in luminal thrombosis and acute coronary syndromes (ACSs)?

Updated: Dec 30, 2019
  • Author: Elena R Ladich, MD; Chief Editor: Allen Patrick Burke, MD  more...
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Patients with acute coronary syndromes (ACSs) classically present with unstable angina, acute myocardial infarction, or sudden coronary death. In approximately 50-60% of sudden coronary death cases, the culprit lesion exhibits an acute coronary thrombus, whereas the remainder of these cases include stable coronary plaques with greater than 75% cross-sectional area luminal narrowing. It is now recognized that the preexisting thin cap fibroatheroma (TCFA) (vulnerable plaque) in approximately 50% of patients dying from sudden thrombotic occlusion occurs as a hemodynamically insignificant lesion. The onset of symptoms and life-threatening complications therefore depend not only on the severity of narrowing in stable chronic anatomic disease but also on critical dynamic morphologicchanges in coronary plaque in the arterial wall.

Sudden luminal thrombosis may arise from three different plaque morphologies: plaque rupture, erosion, and calcified nodule. Of these three, plaque rupture is the most frequent, accounting for 60-75% of cases.

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