From Detecting the Vulnerable Plaque to Managing the Vulnerable Patient

• Published in: Journal of the American College of Cardiology Vol. 74; no. 12; pp. 1582 - 1593
• Main Authors: Arbab-Zadeh, Armin, Fuster, Valentin
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-09-2019
• Subjects: atherosclerosis; coronary artery disease; coronary heart disease; coronary stenosis; myocardial ischemia; atherosclerosis; coronary artery disease; CT; PCI; coronary stenosis; coronary heart disease; myocardial ischemia; CABG; CHD
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2019.07.062

The past decades have seen tremendous progress on elucidating mechanisms leading to acute coronary syndrome and sudden cardiac death. Pathology and imaging studies have identified features of coronary atherosclerosis that precede acute coronary events. However, many factors influence the risk of adverse events from coronary atherosclerotic disease and available data support our transition from focusing on individual “vulnerable plaque,” coronary arterial stenosis, and inducible myocardial ischemia to understanding coronary heart disease as multifactorial, chronic disease. The concept of the vulnerable patient has evolved, with the atheroma burden, its metabolic activity, and the disposition to vascular thrombosis building a platform for assessing central aspects of coronary heart disease. In turn, this model has directed us to a focus on controlling the activity of atherosclerotic disease and on modifying the susceptibility of vascular thrombosis which has led to reduced morbidity and mortality from coronary heart disease.
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•The evaluation and management of patients with coronary heart disease is in transition.•A comprehensive approach to patients with coronary heart disease is replacing a lesion-focused strategy.•Research over the past 4 decades has strengthened the case for prevention and medical therapy as central interventions in patients with coronary heart disease.