Updated pathophysiologic concepts in unstable coronary artery disease

Background The clinical syndrome of unstable angina has multiple causes; di fferent therapies therefore may be indicated in different patients. Methods Recent publications on unstable coronary artery disease were review ed to identify pathophysiologic phenomena and concepts that can aid decisio n-making in the clinical management of patients with unstable coronary arte ry disease of different causes. Results The fate of any coronary plaque depends on local and systemic facto rs. Autopsy studies have revealed that plaques most likely to rupture are t hose with a soft lipid core covered by a thin fibrous cap that may be infla med. Systemic Factors such as hypertension may be maximally expressed at th e site of plaques that are prone to rupture. If an unstable plaque is ident ified, local therapy, such as angioplasty, stents, or radiation, and aggres sive systemic therapy, such as lipid lowering, diabetes control, and hypert ension control, can be used. Conclusions Specific therapy for acute symptoms can be used if the specific cause of the unstable state can be identified. Failure of the plaque to st abilize may result in recurrent ischemia, biochemical evidence for myocardi al damage, and evidence of an inflammatory process. These factors influence prognosis; cardiac events occur more commonly when they are present.