Kristensen S D, Andersen H R, Falk E
Department of Cardiology B, Skejby Hospital, Aarhus, Denmark.
Semin Interv Cardiol. 1999 Mar;4(1):11-6.
Basic knowledge of the sequence of cellular events that change the relative benign disease coronary atherosclerosis into a life-threatening acute coronary syndrome is of great importance for the interventional cardiologist in order to understand and choose the correct pharmacological and interventional management in patients with acute myocardial infarction. Plaque disruption, or fissuring, with superimposed thrombosis frequently complicates the course of coronary atherosclerosis. Small ruptures often remain clinically silent, whereas more extensive plaque rupture may lead to the development of unstable angina, acute myocardial infarction, and sudden cardiac death. The risk of plaque disruption depends more on plaque composition than on plaque size and stenosis severity. Major determinants of a plaque's vulnerability to rupture are: the size and consistency of the lipid-rich atheromatous core, the thickness of the fibrous cap covering the core, and inflammation and repair within the cap. The elevation of fibrinogen and C-reactive protein in patients with unstable angina may be markers of ongoing plaque inflammation. Both plaque vulnerability and rupture triggers are important for plaque disruption. The resultant thrombotic response, which is important for the clinical presentation and outcome, is in part determined by the reactivity of the circulating platelets and the balance between the fibrinolytic and coagulation systems. New ways of identification and treatment of the dangerous vulnerable plaques responsible for infarction and death and optimization of anti-thrombotic treatment are highly warranted in order to prevent and treat life-threatening coronary thrombosis.
了解细胞事件序列的基本知识对于介入心脏病专家至关重要，这些细胞事件会将相对良性的疾病冠状动脉粥样硬化转变为危及生命的急性冠状动脉综合征，以便理解并为急性心肌梗死患者选择正确的药物和介入治疗方法。斑块破裂或裂开，并伴有血栓形成，常常使冠状动脉粥样硬化的病程复杂化。小的破裂通常在临床上没有症状，而更广泛的斑块破裂可能导致不稳定型心绞痛、急性心肌梗死和心源性猝死。斑块破裂的风险更多地取决于斑块的成分，而不是斑块的大小和狭窄程度。斑块易破裂的主要决定因素包括：富含脂质的粥样硬化核心的大小和稠度、覆盖核心的纤维帽的厚度以及帽内的炎症和修复情况。不稳定型心绞痛患者纤维蛋白原和C反应蛋白的升高可能是斑块持续炎症的标志物。斑块易损性和破裂触发因素对于斑块破裂都很重要。由此产生的血栓形成反应对于临床表现和预后很重要，部分取决于循环血小板的反应性以及纤溶系统和凝血系统之间的平衡。为了预防和治疗危及生命的冠状动脉血栓形成，非常有必要采用新的方法来识别和治疗导致梗死和死亡的危险易损斑块，并优化抗血栓治疗。
