MECHANISMS LEADING TO MYOCARDIAL-INFARCTION - INSIGHTS FROM STUDIES OF VASCULAR BIOLOGY
MECHANISMS LEADING TO MYOCARDIAL-INFARCTION - INSIGHTS FROM STUDIES OF VASCULAR BIOLOGY
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DOI：
10.1161/01.cir.90.4.2126
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发表时间：
1994-10-01
期刊：
影响因子：
37.8
通讯作者：
FUSTER, V
中科院分区：
文献类型：
--
作者：
FUSTER, V
心肌梗死是美国以及大多数西方国家最常见的死亡原因。在这篇综述中，根据最新的血管生物学研究描述了导致心肌梗死的过程;此外，还概述了不断发展的预防策略。具体讨论了以下问题。(1)定义了冠状动脉粥样硬化进展的五个阶段（阶段1至5）和八种形态学上不同的病变（I、II、III、IV、Va、Vb、Vc和VI型）。(2)目前的理解的发病机制的每个阶段的进展和心肌梗死前的各种病变类型的描述，特别强调的是放在物理，结构，细胞和化学特性的“脆弱或不稳定的斑块”容易破坏（IV型和Va病变）。(3)斑块破裂的命运（VI型病变）在各种冠状动脉综合征，特别是急性心肌梗死的起源定义;特别强调斑块破裂和高血栓形成风险的组合--局部因素（即斑块破裂程度、富含脂质-巨噬细胞的斑块暴露等）和全身因素（即，儿茶酚胺、RAS、纤维蛋白原等）--在心肌梗死的发生中。(4)在最近的有利经验的背景下，风险因素的修改和脂质修饰血管造影试验，β-阻滞剂和血管紧张素转换酶抑制剂，抗血栓形成的策略，和雌激素的可能作用的背景下，提出的“脆弱或不稳定的斑块”的回归或稳定的预防心肌梗死的策略。最近的过去在更好地理解导致心肌梗死的过程方面取得了丰硕的成果，在预防西方世界的头号杀手方面，不久的将来似乎非常有希望。
Myocardial infarction is the most frequent cause of mortality in the United States as well as in most western countries. In this review, the processes leading to myocardial infarction are described based on the most recent studies of vascular biology; in addition, evolving strategies for prevention are outlined. The following was specifically discussed. (1) Five phases of the progression of coronary atherosclerosis (phases 1 to 5) and eight morphologically different lesions (types I, II, III, IV, Va, Vb, Vc, and VI) in the various phases are defined. (2) The present understanding of the pathogenesis of each of the phases of progression and of the various lesion types preceding myocardial infarction is described; particular emphasis is placed on the physical, structural, cellular, and chemical characteristics of the "vulnerable or unstable plaques" prone to disruption (types IV and Va lesions). (3) The fate of plaque disruption (type VI lesion) in the genesis of the various coronary syndromes and especially acute myocardial infarction is defined; particular emphasis is placed on the combination of plaque disruption and a high thrombogenic risk profile--local factors (ie, degree of plaque disruption, exposure of lipid-macrophage-rich plaque, etc) and systemic factors (ie, catecholamines, RAS, fibrinogen, etc)--in the genesis of myocardial infarction. (4) Strategies of regression or stabilization of "vulnerable or unstable plaques" for prevention of myocardial infarction are presented within the context of recent favorable experience with risk factor modification and lipid-modifying angiographic trials, beta-blockade and angiotensin-converting enzyme inhibition, antithrombotic strategies, and the possible role of estrogens. The recent past has been very fruitful in yielding a better understanding of the processes leading to myocardial infarction, and the near future appears very promising in terms of preventing the number 1 killer in the western world.