Ruptured Plaques and Leaking Cells: Cost-Effectiveness in the Diagnosis of Acute Coronary Syndromes
Authors: Arthur C. Fox, Richard I. Levin
Journal: Annals of Internal Medicine (1999)

Editorials21 December 1999Ruptured Plaques and Leaking Cells: Cost-Effectiveness in the Diagnosis of Acute Coronary SyndromesArthur C. Fox, MD and Richard I. Levin, MDArthur C. Fox, MDNew York University School of Medicine; New York, NY 10016 (Fox)New York University School of Medicine; New York, NY 10016 (Levin)Search for more papers by this author and Richard I. Levin, MDNew York University School of Medicine; New York, NY 10016 (Fox)New York University School of Medicine; New York, NY 10016 (Levin)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-131-12-199912210-00011 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Acute coronary syndromes arise when an atherosclerotic plaque becomes unstable. The cap develops either superficial erosions with overlying thrombus or, more commonly, deep fissures that cause the plaque to swell with clotted blood and encroach on the arterial lumen. Plaques become unstable when the fibrous matrix surrounding the lipid core is attenuated by the action of cytokines from T lymphocytes, which inhibit the synthesis of the matrix, and by metalloproteinases from activated macrophages, which degrade the matrix. The cause of the initial surface breach of the weakened cap may be chemical, caused by reactive oxygen species, or mechanical, caused by ...References1. Davies MJ. Stability and instability: two faces of coronary atherosclerosis. The Paul Dudley White Lecture 1995. Circulation. 1996;94:2013-20. CrossrefMedlineGoogle Scholar2. Libby P. Molecular bases of the acute coronary syndromes. Circulation. 1995;91:2844-50. CrossrefMedlineGoogle Scholar3. Falk E, Shah PK, Fuster V. Coronary plaque disruption. Circulation. 1995;92:657-71. 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Google Scholar Author, Article, and Disclosure InformationAffiliations: New York University School of Medicine; New York, NY 10016 (Fox)New York University School of Medicine; New York, NY 10016 (Levin)Corresponding Author: Arthur C. Fox, MD, Cardiology Section, New York University School of Medicine, 550 First Avenue, New York, NY 10016; e-mail, arthur.[email protected]nyu.edu. For reprint orders in quantities exceeding 100, please contact the Reprints Coordinator; phone, 215-351-2657; e-mail, [email protected]acponline.org.Current Author Addresses: Drs. Fox and Levin: Cardiology Section, New York University School of Medicine, 550 First Avenue, New York, NY 10016. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEmergency Department Triage Strategies for Acute Chest Pain Using Creatine Kinase–MB and Troponin I Assays: A Cost-Effectiveness Analysis Carísi A. Polanczyk , Karen M. Kuntz , David B. Sacks , Paula A. Johnson , and Thomas H. Lee Metrics Cited ByDay 1 care in patients with non-ST-segment elevation myocardial infarctionDiagnosis of Coronary Artery DiseaseRisk Stratification and Prevention in Chronic Coronary Artery Disease: Use of a Novel Prognostic and Computer-Based Clinical Decision Support System in a Large Primary Managed-Care Group Practice 21 December 1999Volume 131, Issue 12Page: 968-970KeywordsAlgorithmsBiomarkersCellsCreatine kinase MBElectrocardiographyEmergency departmentInfarctionIschemiaNecrosisTroponin Issue Published: 21 December 1999 CopyrightCopyright © 1999 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...