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Circulation. 1994;90:2126-2146

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Circulation, Vol 90, 2126-2146, Copyright © 1994 by American Heart Association


ARTICLES

Lewis A. Conner Memorial Lecture. Mechanisms leading to myocardial infarction: insights from studies of vascular biology [published erratum appears in Circulation 1995 Jan 1;91(1):256]

V Fuster
Cardiovascular Institute, Mount Sinai Medical Center, New York, NY 10029-6574.

Myocardial infarction is the most frequent cause of mortality in the United States as well as in most western countries. In this review, the processes leading to myocardial infarction are described based on the most recent studies of vascular biology; in addition, evolving strategies for prevention are outlined. The following was specifically discussed. (1) Five phases of the progression of coronary atherosclerosis (phases 1 to 5) and eight morphologically different lesions (types I, II, III, IV, Va, Vb, Vc, and VI) in the various phases are defined. (2) The present understanding of the pathogenesis of each of the phases of progression and of the various lesion types preceding myocardial infarction is described; particular emphasis is placed on the physical, structural, cellular, and chemical characteristics of the "vulnerable or unstable plaques" prone to disruption (types IV and Va lesions). (3) The fate of plaque disruption (type VI lesion) in the genesis of the various coronary syndromes and especially acute myocardial infarction is defined; particular emphasis is placed on the combination of plaque disruption and a high thrombogenic risk profile--local factors (ie, degree of plaque disruption, exposure of lipid-macrophage-rich plaque, etc) and systemic factors (ie, catecholamines, RAS, fibrinogen, etc)--in the genesis of myocardial infarction. (4) Strategies of regression or stabilization of "vulnerable or unstable plaques" for prevention of myocardial infarction are presented within the context of recent favorable experience with risk factor modification and lipid-modifying angiographic trials, beta-blockade and angiotensin-converting enzyme inhibition, antithrombotic strategies, and the possible role of estrogens. The recent past has been very fruitful in yielding a better understanding of the processes leading to myocardial infarction, and the near future appears very promising in terms of preventing the number 1 killer in the western world.


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M.E Bertrand, M.L Simoons, K.A.A Fox, L.C Wallentin, C.W Hamm, E McFadden, P.J de Feyter, G Specchia, and W Ruzyllo
Management of acute coronary syndromes: acute coronary syndromes without persistent ST segment elevation. Recommendations of the Task Force of the European Society of Cardiology: Recommendations of the Task Force of the European Society of Cardiology
Eur. Heart J., September 1, 2000; 21(17): 1406 - 1432.
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Vasc MedHome page
A. Fischer, D. E Gutstein, Z. A Fayad, and V. Fuster
Predicting plaque rupture: enhancing diagnosis and clinical decision-making in coronary artery disease
Vascular Medicine, August 1, 2000; 5(3): 163 - 172.
[Abstract] [PDF]


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J Am Coll CardiolHome page
G. Pasterkamp, E. Falk, H. Woutman, and C. Borst
Techniques characterizing the coronary atherosclerotic plaque: influence on clinical decision making?
J. Am. Coll. Cardiol., July 1, 2000; 36(1): 13 - 21.
[Abstract] [Full Text] [PDF]


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CLIN APPL THROMB HEMOSTHome page
R. Altman, J. Rouvier, and A. Scazziota
State-of-the-Art Review : Secondary Prevention of Myocardial Infarction: Beneficial Effect of Combining Oral Anticoagulant Plus Aspirin: Therapy Based on Evidence
Clinical and Applied Thrombosis/Hemostasis, July 1, 2000; 6(3): 126 - 134.
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Arterioscler. Thromb. Vasc. Bio.Home page
D. T. Eitzman, R. J. Westrick, Z. Xu, J. Tyson, and D. Ginsburg
Hyperlipidemia Promotes Thrombosis After Injury to Atherosclerotic Vessels in Apolipoprotein E-Deficient Mice
Arterioscler Thromb Vasc Biol, July 1, 2000; 20(7): 1831 - 1834.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
T. Hayashi, M. Jayachandran, D. Sumi, N. K. Thakur, T. Esaki, E. Muto, H. Kano, Y. Asai, and A. Iguchi
Physiological Concentration of 17{beta}-Estradiol Retards the Progression of Severe Atherosclerosis Induced by a High-Cholesterol Diet Plus Balloon Catheter Injury : Role of NO
Arterioscler Thromb Vasc Biol, June 1, 2000; 20(6): 1613 - 1621.
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BloodHome page
N. von Beckerath, W. Koch, J. Mehilli, C. Bottiger, A. Schomig, and A. Kastrati
Glycoprotein Ia gene C807T polymorphism and risk for major adverse cardiac events within the first 30 days after coronary artery stenting
Blood, June 1, 2000; 95(11): 3297 - 3301.
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Arch Intern MedHome page
J. I. Weitz and S. M. Bates
Beyond Heparin and Aspirin: New Treatments for Unstable Angina and Non-Q-Wave Myocardial Infarction
Arch Intern Med, March 27, 2000; 160(6): 749 - 758.
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BloodHome page
D. T. Eitzman, R. J. Westrick, E. G. Nabel, and D. Ginsburg
Plasminogen activator inhibitor-1 and vitronectin promote vascular thrombosis in mice
Blood, January 15, 2000; 95(2): 577 - 580.
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NEJMHome page
Y. Yeghiazarians, J. B. Braunstein, A. Askari, and P. H. Stone
Unstable Angina Pectoris
N. Engl. J. Med., January 13, 2000; 342(2): 101 - 114.
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HeartHome page
S Kojima, H Nonogi, Y Miyao, S Miyazaki, Y Goto, A Itoh, S Daikoku, T Matsumoto, I Morii, and C Yutani
Is preinfarction angina related to the presence or absence of coronary plaque rupture?
Heart, January 1, 2000; 83(1): 64 - 68.
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Arterioscler. Thromb. Vasc. Bio.Home page
Y. Huang, M. Mironova, and M. F. Lopes-Virella
Oxidized LDL Stimulates Matrix Metalloproteinase-1 Expression in Human Vascular Endothelial Cells
Arterioscler Thromb Vasc Biol, November 1, 1999; 19(11): 2640 - 2647.
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RadioGraphicsHome page
W. Stanford
Opening Plenary Session: 1998 : Coronary Artery Calcification as an Indicator of Preclinical Coronary Artery Disease
RadioGraphics, November 1, 1999; 19(6): 1409 - 1419.
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Arterioscler. Thromb. Vasc. Bio.Home page
S. A. Mousa, R. Kapil, and D.-X. Mu
Intravenous and Oral Antithrombotic Efficacy of the Novel Platelet GPIIb/IIIa Antagonist Roxifiban (DMP754) and Its Free Acid Form, XV459
Arterioscler Thromb Vasc Biol, October 1, 1999; 19(10): 2535 - 2541.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
D. Moatti, P. Seknadji, C. Galand, O. Poirier, F. Fumeron, S. Desprez, M. Garbarz, D. Dhermy, D. Arveiler, A. Evans, et al.
Polymorphisms of the Tissue Factor Pathway Inhibitor (TFPI) Gene in Patients With Acute Coronary Syndromes and in Healthy Subjects : Impact of the V264M Substitution on Plasma Levels of TFPI
Arterioscler Thromb Vasc Biol, April 1, 1999; 19(4): 862 - 869.
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BloodHome page
A. Inbal, D. Freimark, B. Modan, A. Chetrit, S. Matetzky, N. Rosenberg, R. Dardik, Z. Baron, and U. Seligsohn
Synergistic Effects of Prothrombotic Polymorphisms and Atherogenic Factors on the Risk of Myocardial Infarction in Young Males
Blood, April 1, 1999; 93(7): 2186 - 2190.
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J Am Coll CardiolHome page
J. D. Folts, A. I. Schafer, J. Loscalzo, J. T. Willerson, and J. E. Muller
A perspective on the potential problems with aspirin as an antithrombotic agent: a comparison of studies in an animal model with clinical trials
J. Am. Coll. Cardiol., February 1, 1999; 33(2): 295 - 303.
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Cardiovasc ResHome page
D. E. Gutstein and V. Fuster
Pathophysiology and clinical significance of atherosclerotic plaque rupture
Cardiovasc Res, February 1, 1999; 41(2): 323 - 333.
[Abstract] [Full Text] [PDF]


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NEJMHome page
R. Ross
Atherosclerosis -- An Inflammatory Disease
N. Engl. J. Med., January 14, 1999; 340(2): 115 - 126.
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Arterioscler. Thromb. Vasc. Bio.Home page
M.-L. M. Gronholdt
Ultrasound and Lipoproteins as Predictors of Lipid-Rich, Rupture-Prone Plaques in the Carotid Artery
Arterioscler Thromb Vasc Biol, January 1, 1999; 19(1): 2 - 13.
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Arterioscler. Thromb. Vasc. Bio.Home page
G. Pasterkamp, A. H. Schoneveld, A. C. van der Wal, D.-J. Hijnen, W. J. A. van Wolveren, S. Plomp, H. L. J. M. Teepen, and C. Borst
Inflammation of the Atherosclerotic Cap and Shoulder of the Plaque Is a Common and Locally Observed Feature in Unruptured Plaques of Femoral and Coronary Arteries
Arterioscler Thromb Vasc Biol, January 1, 1999; 19(1): 54 - 58.
[Abstract] [Full Text] [PDF]


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Psychosom. Med.Home page
R. P. Sloan, P. A. Shapiro, E. Bagiella, M. M. Myers, and J. M. Gorman
Cardiac Autonomic Control Buffers Blood Pressure Variability Responses to Challenge: A Psychophysiologic Model of Coronary Artery Disease
Psychosom Med, January 1, 1999; 61(1): 58 - 68.
[Abstract] [Full Text] [PDF]


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CirculationHome page
A. Katoh, H. Ikeda, T. Murohara, N. Haramaki, H. Ito, and T. Imaizumi
Platelet-Derived 12-Hydroxyeicosatetraenoic Acid Plays an Important Role in Mediating Canine Coronary Thrombosis by Regulating Platelet Glycoprotein IIb/IIIa Activation
Circulation, December 22, 1998; 98(25): 2891 - 2898.
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J Am Coll CardiolHome page
G. Pasterkamp, A. H. Schoneveld, A. C. van der Wal, C. C. Haudenschild, R. J. G. Clarijs, A. E. Becker, B. Hillen, and C. Borst
Relation of arterial geometry to luminal narrowing and histologic markers for plaque vulnerability: the remodeling paradox
J. Am. Coll. Cardiol., September 1, 1998; 32(3): 655 - 662.
[Abstract] [Full Text] [PDF]


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J. Pharmacol. Exp. Ther.Home page
S. A. Mousa, J. M. Bozarth, W. Lorelli, M. S. Forsythe, M. J. M. C. Thoolen, A. M. Slee, T. M. Reilly, and P. A. Friedman
Antiplatelet Efficacy of XV459, A Novel Nonpeptide Platelet GPIIb/IIIa Antagonist: Comparative Platelet Binding Profiles with c7E3
J. Pharmacol. Exp. Ther., September 1, 1998; 286(3): 1277 - 1284.
[Abstract] [Full Text]


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Vasc MedHome page
P. K Shah
Role of inflammation and metalloproteinases in plaque disruption and thrombosis
Vascular Medicine, August 1, 1998; 3(3): 199 - 206.
[Abstract] [PDF]