Atherosclerotic plaque morphology and coronary thrombi

Detailed analysis of coronary lesions from patients with sudden coronary death provides insights into the correlations among sex, coronary risk factors, and patient activity with specific plaque morphologies. In men, acute plaque rupture with thrombus and increased numbers of plaques prone to rupture are associated with elevations in total serum cholesterol, low HDL-C, and an increased ratio of TC to HDL-C. Sudden death related to exercise in men is linked to acute plaque rupture, thinner fibrous caps, increased frequency of plaque hemorrhage, increased vasa vasorum, and more abnormal lipid levels compared with sudden death at rest. Acute plaque rupture in women older than 50 years is also associated with an elevated TC. In women younger than 50 years, plaque erosion, a pathologic entity that is distinct from plaque rupture, accounts for the vast majority of coronary thrombi and correlates with cigarette smoking. In contrast to plaque rupture, plaque erosion is not associated with abnormal lipid levels. Acute coronary plaque rupture or erosion does not invariably result in death, and repetitive healing of ruptures and erosions is a mechanism of stenosis progression in coronary atherosclerosis. Knowledge of pathologic characteristics should help nuclear cardiologists to identify suitable targets and develop appropriate targeting agents.