Atherothrombosis in acute coronary syndromes: mechanisms, markers, and mediators of vulnerability.

We review the concept of atherothrombosis and the critically important role of inflammation in the development of acute coronary syndromes (ACS). Inflammation is now known to be a major driving force underlying the initiation of coronary plaques, their unstable progression, and eventual disruption, and it also contributes significantly to thrombotic complications that occur in ACS. In addition, we discuss the various local mediators and systemic markers that are involved in the inflammatory process, and review the concepts of 'vulnerable plaque,' 'vulnerable blood,' 'vulnerable myocardium,' and the 'vulnerable patient' who is at increased risk for ACS.