The role of plaque rupture and thrombosis in coronary artery disease

Atherosclerosis and its thrombotic complications are the major cause of mor bidity and mortality in the industrialized world. The progression of athero sclerotic plaques in the coronary circulation is dependent on several risk factors. It is now clear that plaque composition is a major determinant of the risk of subsequent plaque rupture and superimposed thrombosis. The vuln erability of plaques to rupture is further determined by extrinsic triggeri ng factors. Following rupture, the fatty core of the plaque and its high co ntent of tissue factor provide a powerful substrate for the activation of t he coagulation cascade. Plaque rupture can be clinically silent or cause sy mptoms of ischaemia depending on thrombus burden and the degree of vessel o cclusion. In addition, plaque rupture and subsequent healing is recognized to be a major cause of further rapid plaque progression. This review looks at the mechanisms underlying the development and progression of atheroscler otic plaques, factors leading to plaque rupture and subsequent thrombosis a nd their clinical consequences. Finally, we speculate on targets for future research. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.