Abstract
Despite significant advances in understanding the pathophysiology of acute coronary insufficiency, myocardial infarction remains a serious health problem for Western society and accounts for approximately one fourth of all deaths in the United States. The most common underlying mechanism is coronary thrombosis superimposed on an atherosclerotic plaque which has been disrupted. Non atherosclerotic mechanisms of infarction account for a minority of clinical events and are of varied etiology (Table 1) (1). Conceptually, these can be considered as those disease processes which lead to luminal obstruction with subsequent ischemia and those which do not involve intrinsic compromise of the lumen. The former group includes entities such as vasculitis and storage disorders which cause diffuse or focal obstruction, while the latter group includes sudden coronary embolus, myocardial oxygen supply-demand mismatch without obstructive coronary disease, hyperviscosity and hypercoagulability states, and trauma. The emphasis of this chapter will be on the events preceding and following the rupture of an atherosclerotic coronary plaque.
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References
Cheitlin MD, McAllister HA, de Castro CM. Myocardial infarction without atherosclerosis. JAMA 1975;231:951–959.
Stary H. Evolution and progression of atherosclerotic lesions in coronary arteries of children and young adults. Arteriosclerosis 1989;9(Suppl I): 19–32.
Fuster V, Badimon L, Badimon JJ, Chesebro JH. The pathogenesis of coronary artery disease and the acute ischemic syndromes. N Engl J Med 1992;326:232–250; 310-318.
Fuster V, Stein B, Ambrose JA, Badimon L, Badimon JJ, Chesebro JH. Atheroscle-rotic plaque rupture and thrombosis: Evolving Concepts. Circulation 1990;82(suppl II):47–59.
Fuster V, Badimon L, Cohen M, Ambrose JA, Badimon JJ, Chesebro JH. Insights into the pathogenesis of acute ischemic syndromes. Circulation 1988;77:1213–1220.
Davies M. A macro and micro view of coronary vascular insult in ischemic heart disease. Circulation 1990;82(suppl II);38–46.
Jonasson L, Holm J, Skailli O, Bondjers G, Hansson GK. Regional accumulation of T cells, macrophages, and smooth muscle cells in the human atherosclerotic plaque. Arteriosclerosis 1986;6:131–138.
Mitchinson MJ, Ball RY. Macrophages and atherogenesis. Lancet 1987;2:146–148.
Epstein SE, Cannon RO. Site of increased resistance to coronary flow in patients with angina pectoris and normal epicardial arteries. J AM Coll Cardiol 1986;8:459–461.
Falk E. Unstable angina with fatal outcome: Dynamic coronary thrombosis leading to infarction and/or sudden death. Circulation 1985;71:699–708.
Constantinides P. Plaque fissures in human coronary artery thrombosis. J Atheroscler Res 1966;6:1–17.
Kragel AH, Gertz SD, Roberts WC. Morphologic comparison of frequency and types of acute lesions in the major epicardial coronary arteries in unstable angina pectoris, sudden coronary death and acute myocardial infarction. J Am Coll Cardiol 1991;18:801–808.
Nakagawa S, Hanada Y, Koiwaya Y, Tanaka K. Angiographic features in the infarct-related artery after intracoronary urokinase followed by prolonged anticoagulation. Role of ruptured atheromatous plaque and adherent thrombus in acute myocardial infarction in vivo. Circulation 1988;78:1335–1344.
Rentrop KP, Feit F, Sherman W, Thornton JC. Serial angiographie assessment of coronary artery obstruction and collateral flow in acute myocardial infarction. Circulation 1989;80:1166–1175.
Richardson PD, Davies MJ, Born GVR. Influence of plaque configuration and stress distribution on fissuring of coronary atherosclerotic plaques. Lancet 1989;2:941–944.
Ridolfi RL, Hutchins GM. The relationship between coronary artery lesions and myocardial infarcts: Ulceration of atherosclerotic plaques precipitating coronary thrombosis. Am Heart J 1977;93:468–486.
Ambrose JA, Tannenbaum MA, Alexopoulos D, et al. Angiographie progression of coronary artery disease and the development of myocardial infarction. J Am Coll Cardiol 1988;12:56–62.
Ambrose JA. Prognostic implications of lesion irregularity on coronary angiography. J Am Coll Cardiol 1991;18:675–676.
Little WC, Constantinescu M, Applegate RJ, et al. Can coronary angiography predict the site of a subsequent myocardial infarction in patients with mild-to-moderate coronary artery disease? Circulation 1988;78:1157–1166.
Brown BG, Gallery CA, Badger RS, et al. Incomplete lysis of thrombus in the moderate underlying atherosclerotic lesion during intracoronary infusion of streptokinase for acute myocardial infarction: Quantitative angiographic observations. Circulation 1986;73:653–661.
Davies SW, Marchant B, Lyons JP, et al. Irregular coronary morphology after thrombolysis predicts early clinical instability. J Am Coll Cardiol 1991;18:669–674.
Badimon L, Badimon JJ, Turrito VT, Vallabhajosula S, Fuster V. Platelet thrombus formation on collagen type I: A model of deep vessel injury: Influence of blood rheology, von Willebrand factor, and blood coagulation. Circulation 1988;78:1431–1442.
Badimon L, Badimon JJ. Mechanism of arterial thrombosis in nonparallel streamlines: Platelet thrombi grow at the apex of stenotic severely injured vessel wall: Experimental study in the pig model. J Clin Invest 1989;84:1134–1144.
Lassila R, Badimon JJ, Vallabhajosula S, Badimon L. Dynamic monitoring of platelet deposition on severely damaged vessel wall in flowing blood: Effects of different stenosis on thrombus growth. Arteriosclerosis 1990;10:306–315.
Hirsh PD, Hillis LD, Campbell WB, Firth BG, Willerson JT. Release of prostaglandins and thromboxane into the coronary circulation in patients with ischemic heart disease. N Engl J Med 1981;304:685–691.
van der Berg EK, Schmitz JM, Benedict CR, Malloy CR, Willerson JT, Dehmer GJ. Transcardiac serotonin concentration is increased in selected patients with limiting angina complex coronary lesion morphology. Circulation 1989;79:116–124.
Fitzgerald DJ, Roy L, Catella F, Fitzgerald GA. Platelet activation in unstable coronary disease. N Engl J Med 1986;315:983–989.
Fitzgerald DJ, Roy L, Catella F, Fitzgerald GA. Marked platelet activation in vivo after intravenous streptokinase in patients with acute myocardial infarction. Circulation 1988;77:142–150.
Grignani G, Soffiantino F, Zuchella M, et al. Platelet activation by emotional stress in patients with coronary artery disease. Circulation 1991;83:(suppl II) 128–136.
Toiler GH, Brezinski D, Shafer AI, et al. Concurrent morning increase in platelet aggregability and the risk of myocardial infarction and sudden cardiac death. N Engl J Med 1987;316:1514–1518.
Aznar J, Estellas A, Tormo G, et al. Plasminogen activator inhibitor activity and other fibrinolytic variables in patients with coronary artery disease. Br Heart J 1988;59:535–541.
Loscalzo J. Lipoprotein (a): A unique risk factor for atherothrombotic disease. Arteriosclerosis 1990;10:672–679.
Wilhelmson L, Svardsudd K, Korsan-Bengtsen K, Larson B, Welin L, Tibblin G. Fibrinogen as a risk factor for stroke and myocardial infarction. N Engl J Med 1984;311:501–505.
Hackett D, Davies G, Chiercha S, Maseri A. Intermittent coronary occlusion in acute myocardial infarction: Value of combined thrombolytic and vasodilatory therapy. N Engl J Med 1987;317:1055–1059.
Vane JR, Annggard EE, Botting RM. Regulatory functions of the vascular endothelium. N Engl J Med 1990;323:27–36.
Yanagisawa M, Kurihara H, Kimura S, et al. A novel potent vasoconstrictor peptide produced by vascular endothelial cells. Nature 1988;332:411–415.
Zeiher AM, Drexler H, Wollschlager H, Just H. Modulation of coronary vasomotor tone in humans: Progressive endothelial dysfunction with different early stages of coronary atherosclerosis. Circulation 1991;83:391–401.
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© 1994 Springer Science+Business Media New York
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Ferrell, M., Fuster, V. (1994). Mechanisms of Acute Myocardial Infarction. In: Becker, R.C. (eds) The Modern Era of Coronary Thrombolysis. Developments in Cardiovascular Medicine, vol 160. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-2618-6_1
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DOI: https://doi.org/10.1007/978-1-4615-2618-6_1
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