Bimodal presentation of the clinical syndromes of coronary atherosclerosis: a review.

Recent clinical, angiographic, and pathologic evidence has prompted reexamination of the natural history of coronary atherosclerosis. Abrupt anatomic complications of atherosclerotic plaques or thrombosis on a plaque may precipitate the "malignant" syndromes of sudden death, acute myocardial infarction, or unstable angina before the plaque itself is large enough to limit coronary flow. This concept of a bimodal pattern of presentation has important clinical and therapeutic implications.