Naghavi Morteza, Libby Peter, Falk Erling, Casscells S Ward, Litovsky Silvio, Rumberger John, Badimon Juan Jose, Stefanadis Christodoulos, Moreno Pedro, Pasterkamp Gerard, Fayad Zahi, Stone Peter H, Waxman Sergio, Raggi Paolo, Madjid Mohammad, Zarrabi Alireza, Burke Allen, Yuan Chun, Fitzgerald Peter J, Siscovick David S, de Korte Chris L, Aikawa Masanori, Airaksinen K E Juhani, Assmann Gerd, Becker Christoph R, Chesebro James H, Farb Andrew, Galis Zorina S, Jackson Chris, Jang Ik-Kyung, Koenig Wolfgang, Lodder Robert A, March Keith, Demirovic Jasenka, Navab Mohamad, Priori Silvia G, Rekhter Mark D, Bahr Raymond, Grundy Scott M, Mehran Roxana, Colombo Antonio, Boerwinkle Eric, Ballantyne Christie, Insull William, Schwartz Robert S, Vogel Robert, Serruys Patrick W, Hansson Goran K, Faxon David P, Kaul Sanjay, Drexler Helmut, Greenland Philip, Muller James E, Virmani Renu, Ridker Paul M, Zipes Douglas P, Shah Prediman K, Willerson James T
The Center for Vulnerable Plaque Research, University of Texas-Houston, The Texas Heart Institute, and President Bush Center for Cardiovascular Health, Memorial Hermann Hospital, Houston, USA.
Circulation. 2003 Oct 14;108(15):1772-8. doi: 10.1161/01.CIR.0000087481.55887.C9.
Atherosclerotic cardiovascular disease results in >19 million deaths annually, and coronary heart disease accounts for the majority of this toll. Despite major advances in treatment of coronary heart disease patients, a large number of victims of the disease who are apparently healthy die suddenly without prior symptoms. Available screening and diagnostic methods are insufficient to identify the victims before the event occurs. The recognition of the role of the vulnerable plaque has opened new avenues of opportunity in the field of cardiovascular medicine. This consensus document concludes the following. (1) Rupture-prone plaques are not the only vulnerable plaques. All types of atherosclerotic plaques with high likelihood of thrombotic complications and rapid progression should be considered as vulnerable plaques. We propose a classification for clinical as well as pathological evaluation of vulnerable plaques. (2) Vulnerable plaques are not the only culprit factors for the development of acute coronary syndromes, myocardial infarction, and sudden cardiac death. Vulnerable blood (prone to thrombosis) and vulnerable myocardium (prone to fatal arrhythmia) play an important role in the outcome. Therefore, the term "vulnerable patient" may be more appropriate and is proposed now for the identification of subjects with high likelihood of developing cardiac events in the near future. (3) A quantitative method for cumulative risk assessment of vulnerable patients needs to be developed that may include variables based on plaque, blood, and myocardial vulnerability. In Part I of this consensus document, we cover the new definition of vulnerable plaque and its relationship with vulnerable patients. Part II of this consensus document will focus on vulnerable blood and vulnerable myocardium and provide an outline of overall risk assessment of vulnerable patients. Parts I and II are meant to provide a general consensus and overviews the new field of vulnerable patient. Recently developed assays (eg, C-reactive protein), imaging techniques (eg, CT and MRI), noninvasive electrophysiological tests (for vulnerable myocardium), and emerging catheters (to localize and characterize vulnerable plaque) in combination with future genomic and proteomic techniques will guide us in the search for vulnerable patients. It will also lead to the development and deployment of new therapies and ultimately to reduce the incidence of acute coronary syndromes and sudden cardiac death. We encourage healthcare policy makers to promote translational research for screening and treatment of vulnerable patients.
动脉粥样硬化性心血管疾病每年导致超过1900万人死亡，其中冠心病占死亡总数的大部分。尽管冠心病患者的治疗取得了重大进展，但大量看似健康的该病患者会突然毫无先兆地死亡。现有的筛查和诊断方法不足以在事件发生前识别出这些患者。对易损斑块作用的认识为心血管医学领域开辟了新的机遇。本共识文件得出以下结论：（1）易破裂斑块并非唯一的易损斑块。所有具有血栓形成并发症高可能性且进展迅速的动脉粥样硬化斑块都应被视为易损斑块。我们提出了一种用于易损斑块临床及病理评估的分类方法。（2）易损斑块并非急性冠状动脉综合征、心肌梗死和心源性猝死发生的唯一罪魁祸首。易损血液（易于形成血栓）和易损心肌（易于发生致命性心律失常）在疾病转归中起重要作用。因此，“易损患者”这一术语可能更合适，现提议用于识别近期发生心脏事件可能性高的个体。（3）需要开发一种易损患者累积风险评估的定量方法，该方法可能包括基于斑块、血液和心肌易损性的变量。在本共识文件的第一部分，我们阐述了易损斑块的新定义及其与易损患者的关系。本共识文件的第二部分将聚焦于易损血液和易损心肌，并概述易损患者的总体风险评估。第一部分和第二部分旨在达成总体共识并概述易损患者这一新领域。最近开发的检测方法（如C反应蛋白）、成像技术（如CT和MRI）、无创电生理检查（用于检测易损心肌）以及新兴导管（用于定位和表征易损斑块），再结合未来的基因组学和蛋白质组学技术，将指导我们寻找易损患者。这也将促使新疗法的开发和应用，最终降低急性冠状动脉综合征和心源性猝死的发生率。我们鼓励医疗保健政策制定者推动针对易损患者筛查和治疗的转化研究。
