Περίληψη:
Atherosclerotic cardiovascular disease results in >19 million deaths
annually, and coronary heart disease accounts for the majority of this
toll. Despite major advances in treatment of coronary heart disease
patients, a large number of victims of the disease who are apparently
healthy die suddenly without prior symptoms. Available screening and
diagnostic methods are insufficient to identify the victims before the
event occurs. The recognition of the role of the vulnerable plaque has
opened new avenues of opportunity in the field of cardiovascular
medicine. This consensus document concludes the following. (1)
Rupture-prone plaques are not the only vulnerable plaques. All types of
atherosclerotic plaques with high likelihood of thrombotic complications
and rapid progression should be considered as vulnerable plaques. We
propose a classification for clinical as well as pathological evaluation
of vulnerable plaques. (2) Vulnerable plaques are not the only culprit
factors for the development of acute coronary syndromes, myocardial
infarction, and sudden cardiac death. Vulnerable blood (prone to
thrombosis) and vulnerable myocardium (prone to fatal arrhythmia) play
an important role in the outcome. Therefore, the term “vulnerable
patient” may be more appropriate and is proposed now for the
identification of subjects with high likelihood of developing cardiac
events in the near future. (3) A quantitative method for cumulative risk
assessment of vulnerable patients needs to be developed that may include
variables based on plaque, blood, and myocardial vulnerability. In Part
I of this consensus document, we cover the new definition of vulnerable
plaque and its relationship with vulnerable patients. Part II of this
consensus document focuses on vulnerable blood and vulnerable myocardium
and provide an outline of overall risk assessment of vulnerable
patients. Parts I and II are meant to provide a general consensus and
overviews the new field of vulnerable patient. Recently developed assays
(eg, C-reactive protein), imaging techniques (eg, CT and MRI),
noninvasive electrophysiological tests (for vulnerable myocardium), and
emerging catheters (to localize and characterize vulnerable plaque) in
combination with future genomic and proteomic techniques will guide us
in the search for vulnerable patients. It will also lead to the
development and deployment of new therapies and ultimately to reduce the
incidence of acute coronary syndromes and sudden cardiac death. We
encourage healthcare policy makers to promote translational research for
screening and treatment of vulnerable patients.
Συγγραφείς:
Naghavi, M
Libby, P
Falk, E
Casscells, SW
Litovsky, S
and Rumberger, J
Badimon, JJ
Stefanadis, C
Moreno, P and
Pasterkamp, G
Fayad, Z
Stone, PH
Waxman, S
Raggi, P and
Madjid, M
Zarrabi, A
Burke, A
Yuan, C
Fitzgerald, PJ and
Siscovick, DS
de Korte, CL
Aikawa, M
Airaksinen, KEJ and
Assmann, G
Becker, CR
Chesebro, JH
Farb, A
Galis, ZS and
Jackson, C
Jang, IK
Koenig, W
Lodder, RA
March, K and
Demirovic, J
Navab, M
Priori, SG
Rekhter, MD
Bahr, R and
Grundy, SM
Mehran, R
Colombo, A
Boerwinkle, E and
Ballantyne, C
Insull, W
Schwartz, RS
Vogel, R
Serruys,
PW
Hansson, GK
Faxon, DP
Kaul, S
Drexler, H and
Greenland, P
Muller, JE
Virmani, R
Ridker, PM
Zipes, DP
and Shah, PK
Willerson, JT
