Elucidation of the role of plaque instability and rupture in acute coronary events.

The basic mechanisms of atherosclerotic progression have been well elucidated during the last few years. In this brief presentation on the acute coronary syndromes, the fate of plaque rupture and our understanding of "passive" versus "active" rupture are defined. In addition to the phenomenon of plaque rupture, the thrombogenicity of atherosclerotic plaques in the genesis of coronary syndromes is defined. The combination of plaque disruption and high thrombogenic risk profile--including local and systemic factors--is vital to understanding the genesis of the acute coronary syndromes.