Lewis A. Conner Memorial Lecture. Mechanisms leading to myocardial infarction: insights from studies of vascular biology.

摘要: Myocardial infarction is the most frequent cause of mortality in United States as well western countries. In this review, processes leading to myocardial are described based on recent studies vascular biology; addition, evolving strategies for prevention outlined. The following was specifically discussed. (1) Five phases progression coronary atherosclerosis (phases 1 5) and eight morphologically different lesions (types I, II, III, IV, Va, Vb, Vc, VI) various defined. (2) present understanding pathogenesis each lesion types preceding described; particular emphasis placed physical, structural, cellular, chemical characteristics "vulnerable or unstable plaques" prone disruption IV Va lesions). (3) fate plaque (type VI lesion) genesis syndromes especially acute defined; combination a high thrombogenic risk profile--local factors (ie, degree disruption, exposure lipid-macrophage-rich plaque, etc) systemic catecholamines, RAS, fibrinogen, etc)--in infarction. (4) Strategies regression stabilization presented within context favorable experience with factor modification lipid-modifying angiographic trials, beta-blockade angiotensin-converting enzyme inhibition, antithrombotic strategies, possible role estrogens. past has been very fruitful yielding better infarction, near future appears promising terms preventing number killer world.