Interv Akut Kardiol. 2003;2(2):69-72

NEW INSIGHTS INTO THE PATHOPHYSIOLOGY OF ACUTE CORONARY SYNDROME

Jan Vojáček^1,2, Martin Mates², Vladimír Hraboš³

¹ I. interní klinika Fakultní nemocnice v Hradci Králové

² Kardiocentrum dospělých, oddělení invazivní kardiologie interní kliniky 2. LF UK a FN Motol, Praha

³ Kardiologické oddělení, Krajská nemocnice Liberec

Coronary lesions in patients with acute coronary syndrome are usually multifocal. Intracoronary ultrasound examination of all three coronary arteries in patients with troponine-pozitive acute coronary syndrome demonstrated in almost 80 % of patients more than one culprit lesion located in any part of coronary vascular bed.

Circulating monocytes and platelets and their interactions are responsible for the development of coronary thrombosis. Activated monocytes express tissue factor, some cytokines and matrix metalloproteinases. The importance of CD40 receptor on monocytes, endothelial cells and smooth muscle cells and its interaction with CD40 ligand shed by platelets was recognized. Matrix metalloproteinases are found not only in the histological specimens of ruptured plaque but their levels are also increased in the plasma of patients with acute coronary syndrome.

Invasive treatment of patients with acute coronary syndrome proved to improve their prognosis. However, adjunctive treatment with potent antiplatelet drugs, such as platelet GP IIb/IIIa receptor inhibitor and ADP pathway blockers also improve long-term survival of patients with acute coronary syndromes.

Keywords: acute coronary syndrome, platelets, monocytes, multifocal coronary involvement.

Published: December 31, 2003  Show citation