New prediction tools and treatment for ACS patients with plaque erosion
For decades, we have known from autopsy observations that the proximate cause of the majority of acute coronary syndromes (ACS) is occlusive thrombosis generated by plaque rupture or, less frequently, superficial erosion.1-3 Mounting evidence supports the concept that these two substrates are separate entities, with distinct pathogenesis, clinical presentation, and prognosis.4-9 Yet, when ACS patients present to the emergency department with ischemic symptoms, we still triage them exclusively based on the presence or absence of ST-segment elevation on electrocardiogram and/or on troponin levels, assess them using coronary angiography, and manage them almost invariably with percutaneous coronary intervention ...
