急性冠脉综合征(ACS)解读.ppt

Slide 3 Atherothrombosis: a Generalized and Progressive Process Atherothrombosis is the common underlying disease process for MI, ischemia and vascular death. ACS are classic examples of atherothrombosis (plaque rupture and thrombus formation). ACS (in common with ischemic stroke and critical leg ischemia) are typically caused by rupture or erosion of an atherosclerotic plaque followed by formation of a platelet-rich thrombus. Atherosclerosis is an ongoing process affecting mainly large and medium-sized arteries, which can begin in childhood and progress throughout a person’s lifetime. Stable atherosclerotic plaques may encroach on the lumen of the artery and cause chronic ischemia, resulting in (stable) angina pectoris or intermittent claudication, depending on the vascular bed affected. Unstable atherosclerotic plaques may rupture, leading to the formation of a platelet-rich thrombus that partially or completely occludes the artery and causes acute ischemic symptoms. References: 1. Yun DD, Alpert JS. Cardiology 1997; 88: 223–37. 2. Davies MJ. Circulation 1990; 82(suppl. II): 1138–46. 3. Fuster V. Circulation 1994: 94: 2126–46. 4. Hamm CW et al. N Engl J Med 1992; 327: 146–50. Acute coronary syndrome (ACS), notably unstable angina or non-Q-wave myocardial infarction (MI), are classic manifestations of atherothrombosis. The common link between unstable angina and non-Q-wave MI, and Q-wave MI is that thrombus formation occurs secondary to rupture or fissuring of an atherosclerotic plaque in the coronary arteries.1 This leads to thrombotic occlusion of the coronary artery with interruption of blood flow, resulting in myocardial ischemia and/or necrosis (death of myocardial cells).2,3 Patients with ACS are at high risk of a subsequent life-threatening atherothrombotic event such as MI, stroke or vascular death.4 Slide 4 Pathophysiology of ACS Various factors affect the risk that an atherosclerotic plaque will rupture, including the tensile strength of the f