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Pathophysiology NSTEMI 2022
Pathophysiology NSTEMI 2022
Pathophysiology NSTEMI 2022
UA/NSTEMI/STEMI
Davies MJ
Heart 83:361, 2000
No ST Elevation ST Elevation
NSTEMI
Myocardial Infarction
Uns Angina NQMI Qw MI
Vulnerable Plaque
Systemic
Conditions
Atherothrombotic • Hypertension
Genetic Traits • Hyperlipidemia
• FH Manifestations
• Diabetes
• Lp (a) (MI, stroke, • Hypercoagulable
• Polygenic vascular death) states
risk
Inflammation
• Elevated CRP
Local Factors
• IL-6
• Blood flow patterns
• Prothrombotic factors Fibrinogen
• Shear stress
• Vessel diameter
MI, myocardial infarction. • Arterial wall structure
Adapted from Yusuf S, et al. Circulation. 2001;104:2746-2753. • % arterial stenosis
Drouet L. Cerebrovasc Dis. 2002;13(suppl 1):1-6.
Frequency of Multiple “Active” Plaques in
Patients With ACS
80% of Patients With ≥ 2 Plaques
30 N=24
25
20
Patients (%)
15
10
0
0 1 2 3 4 5
Frequency of multiple active plaque ruptures beyond the culprit lesion
Rupture Erosion
Cocaine
Takotsubo
Myocarditis Alternate diagnosis
cardiomyopathy