Author + information
- Received September 6, 2014
- Revision received November 4, 2014
- Accepted November 25, 2014
- Published online March 3, 2015.
- ∗Department of Medicine, Cardiology Division, Johns Hopkins University, Baltimore, Maryland
- †Mount Sinai Medical Center, Icahn School of Medicine, New York, New York
- ↵∗Reprint requests and correspondence:
Dr. Armin Arbab-Zadeh, Johns Hopkins University, Division of Cardiology, 600 N. Wolfe Street, Blalock 524, Baltimore, Maryland 21287-8222.
The cardiovascular science community has pursued the quest to identify vulnerable atherosclerotic plaque in patients for decades, hoping to prevent acute coronary events. However, despite major advancements in imaging technology that allow visualization of rupture-prone plaques, clinical studies have not demonstrated improved risk prediction compared with traditional approaches. Considering the complex relationship between plaque rupture and acute coronary event risk suggested by pathology studies and confirmed by clinical investigations, these results are not surprising. This review summarizes the evidence supporting a multifaceted hypothesis of the natural history of atherosclerotic plaque rupture. Managing patients at risk of acute coronary events mandates a greater focus on the atherosclerotic disease burden rather than on features of individual plaques.
Dr. Zadeh is supported by grant K23-HL098368 from the National Institutes of Health. Dr. Fuster has reported that he has no relationships relevant to the contents of this paper to disclose.
Peter Libby, MD, served as Guest Editor for this paper.
- Received September 6, 2014.
- Revision received November 4, 2014.
- Accepted November 25, 2014.
- 2015 American College of Cardiology Foundation
- The “Vulnerable Plaque” Concept
- Limitations of Studies Supporting the High-Risk Atherosclerotic Plaque Concept
- Evidence Diminishing the Significance of Identifying “High-Risk” Plaques
- Current Paradigm of Acute Coronary Event Pathophysiology
- Lesion Focused Versus Disease Burden Focused Risk Assessment and Management
- Areas of Uncertainty: Influence of Study Population
- Is There a Role for Individual Plaque Imaging?
- Implications for Future Investigations