Epidemiology and Pathophysiology of Acute Coronary Syndrome

Acute coronary syndrome (ACS), one of the life-threatening manifestations of coronary artery disease, ranges from unstable angina, to acute myocardial infarction (non—ST elevation and ST elevation), to sudden cardiac death. The pathophysiology of ACS in the vast majority of cases involves coronary thrombosis overlying a disrupted atherosclerotic plaque [1]. Several autopsy studies have demonstrated that 70% to 80% of coronary thrombi occur at sites where the fi brous cap of coronary artery plaque has ruptured, with extension of the thrombus into the plaque and into the lumen, as well as with propagation of the thrombus upstream from the site of cap rupture [2, 3]. Although it would be preferable to prevent ACS rather than treat it after its occurrence, currently there is no optimal laboratory or imaging modality to predict its timing. Therefore, risk-factor modifi cation is the best approach until reliable, noninvasive tests become available.