1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece.
2nd Department of Cardiology, "Hippokration" General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece.
Int J Mol Sci. 2024 May 26;25(11):5786. doi: 10.3390/ijms25115786.
Plaque erosion (PE), a distinct etiology of acute coronary syndromes (ACSs), is often overshadowed by plaque ruptures (PRs). Concerning its epidemiology, PE has garnered increasing recognition, with recent studies revealing its prevalence to be approximately 40% among ACS patients, challenging earlier assumptions based on autopsy data. Notably, PE exhibits distinct epidemiological features, preferentially affecting younger demographics, particularly women, and often manifesting as a non-ST-segment elevation myocardial infarction. There are seasonal variations, with PE events being less common in winter, potentially linked to physiological changes and cholesterol solidification, while peaking in summer, warranting further investigation. Moving to molecular mechanisms, PE presents a unique profile characterized by a lesser degree of inflammation compared to PR, with endothelial shear stress emerging as a plausible molecular mechanism. Neutrophil activation, toll-like receptor-2 pathways, and hyaluronidase 2 expression are among the factors implicated in PE pathophysiology, underscoring its multifactorial nature. Advancements in intravascular imaging diagnostics, particularly optical coherence tomography and near-infrared spectroscopy coupled with intravascular ultrasound, offer unprecedented insights into plaque composition and morphology. Artificial intelligence algorithms show promise in enhancing diagnostic accuracy and streamlining image interpretation, augmenting clinician decision-making. Therapeutically, the management of PE evolves, with studies exploring less invasive approaches such as antithrombotic therapy without stenting, particularly in cases identified early through intravascular imaging. Additionally, the potential role of drug-coated balloons in reducing thrombus burden and minimizing future major adverse cardiovascular events warrants further investigation. Looking ahead, the integration of advanced imaging modalities, biomarkers, and artificial intelligence promises to revolutionize the diagnosis and treatment of coronary PE, ushering in a new era of personalized and precise cardiovascular care.
斑块侵蚀（PE）是急性冠脉综合征（ACS）的一种独特病因，常被斑块破裂（PR）所掩盖。关于其流行病学，PE 越来越受到关注，最近的研究表明，在 ACS 患者中，PE 的患病率约为 40%，这与基于尸检数据的早期假设形成了挑战。值得注意的是，PE 表现出独特的流行病学特征，优先影响年轻人群，特别是女性，并且常表现为非 ST 段抬高型心肌梗死。PE 存在季节性变化，冬季 PE 事件较少，可能与生理变化和胆固醇凝固有关，而夏季则达到高峰，需要进一步研究。进一步探讨分子机制，PE 表现出与 PR 相比炎症程度较轻的独特特征，内皮剪切应力被认为是一种合理的分子机制。中性粒细胞激活、Toll 样受体-2 途径和透明质酸酶 2 表达是 PE 病理生理学中的相关因素，强调了其多因素性质。血管内成像诊断技术的进步，特别是光学相干断层扫描和近红外光谱与血管内超声相结合，提供了对斑块成分和形态的前所未有的深入了解。人工智能算法在提高诊断准确性和简化图像解释方面显示出潜力，增强了临床医生的决策能力。在治疗方面，PE 的管理不断发展，研究探索了不介入治疗如抗血栓治疗而不放置支架的方法，特别是通过血管内成像早期识别的病例。此外，药物涂层球囊在减少血栓负荷和最小化未来主要不良心血管事件方面的潜在作用值得进一步研究。展望未来，先进成像模式、生物标志物和人工智能的整合有望彻底改变冠状动脉 PE 的诊断和治疗，开创个性化和精准心血管护理的新时代。
