Chapter 2.5 – Acute Coronary Syndromes

Among other clinical presentations of coronary artery disease, acute coronary syndromes (ACS) are particularly worrisome as they are prevalent but at the same time portend a worse prognosis. ACS represents a life-threatening manifestation of atherosclerosis. Pathological, imaging, and biological observations have demonstrated that atherosclerotic plaque rupture or erosion, with differing degrees of superimposed thrombosis form the basic pathophysiological mechanisms in most conditions of ACS. During the last decades, rapid progress has been made in understanding its pathophysiology. New studies have provided new elements for the identification of a vulnerable plaque and/or patient. Ultimately, plaque destabilization seems to be a biomechanical phenomenon that depends on a complex interplay between structural features, biological processes and applied exogenous forces and stresses. This chapter is focused on the pathophysiological and biological processes related to the stepwise progression of atherosclerotic plaques and plaque destabilization leading eventually to ACS. Current methods that can potentially be used to identify high-risk plaques and aid in the management of ACS are also discussed.