From Atherosclerotic Plaque to Myocardial Infarction-The Leading Cause of Coronary Artery Occlusion

Abstract

Cardiovascular disease (CVD) constitutes the most common cause of death worldwide. In Europe alone, approximately 4 million people die annually due to CVD. The leading component of CVD leading to mortality is myocardial infarction (MI). MI is classified into several types. Type 1 is associated with atherosclerosis, type 2 results from inadequate oxygen supply to cardiomyocytes, type 3 is defined as sudden cardiac death, while types 4 and 5 are associated with procedures such as percutaneous coronary intervention and coronary artery bypass grafting, respectively. Of particular note is type 1, which is also the most frequently occurring form of MI. Factors predisposing to its occurrence include, among others, high levels of low-density lipoprotein cholesterol (LDL-C) in the blood, cigarette smoking, chronic kidney disease (CKD), diabetes mellitus (DM), hypertension, and familial hypercholesterolaemia (FH). The primary objective of this review is to elucidate the issues with regard to type 1 MI. Our paper delves into, amidst other aspects, its pathogenesis, risk assessment, diagnosis, pharmacotherapy, and interventional treatment options in both acute and long-term conditions.

Keywords: atherosclerosis; cardiovascular disease; myocardial infarction.

Figure 1

Figure depicting the pathogenesis of atherosclerotic plaque development [7]. Abbreviations: oxLDL—oxidised low-density lipoprotein, ROS—reactive oxygen species, RBC—red blood cells.

Figure 2

Conditions that may increase hs-cTn levels [1,11]. Abbreviations: hs-cTn, high-sensitivity cardiac troponin; HF, heart failure.

Figure 3

Risk criteria for patients with NSTE-ACS. Abbreviations: CS cardiogenic shock; HF heart failure; MI myocardial infarction; ECG electrocardiogram, NSTEMI non-ST-elevation myocardial infarction.

Figure 4

An overview of the comprehensive management of patients presenting with ACS. Abbreviations: ECG, electrocardiogram; hs-cTn, high-sensitivity cardiac troponin; STEMI, ST-elevation myocardial infarction; NSTE-ACS, non-ST-elevation acute coronary syndrome; PPCI, primary percutaneous coronary intervention; CABG, coronary artery bypass grafting.