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Introduction Acute coronary syndromes (ACSs) and ischemic sudden death often develop spontaneously in patients with previously unrecognized coronary artery disease. Despite the aggressive use of medications to reduce the deleterious effects of hypertension and cholesterol, patients with documented coronary atherosclerosis, or at high risk of developing the disease, continue to suffer its complications. Biomarkers may predict groups of patients with increased risk of future instability, studies using CT angiography (CTA) have shown an increased risk of ischemic events in patients with elevated calcium scores, complex lesions on coronary angiography have an increased risk of progressing to closure, and intravascular ultrasound has shown that lesions that are angiographically silent can have substantial plaque burden. However, none of these approaches can be used with certainty to demonstrate the presence of a lesion with an increased risk of a subsequent transformation into a vulnerable plaque causing an acute ischemic syndrome in a specific patient over a finite period of time. As a result, new approaches have been conceptualized which may be able to diagnose those lesions with an increased risk of rupture over the ensuing 1 to 2 years. This review will discuss the scope of the problem, the difficulties in
Journal of Interventional Cardiology – Wiley
Published: Dec 1, 2008
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