Acute coronary syndromes without coronary plaque rupture

Disruption of the fibrous cap on vulnerable atherosclerotic coronary plaques leads to exposure of the thrombogenic lipid core to the bloodstream, and is responsible for two-thirds of all coronary eventsIn approximately one-third of patients with acute coronary syndrome (ACS), the thrombus develops after intimal erosion without fibrous cap ruptureAdvances in plaque imaging have allowed clinicians to treat patients with ACS based not only on clinical manifestations, angiographic characteristics, and biomarker data, but also on plaque morphologyThe use of optical coherence tomography without angiographically obvious plaque rupture can assist in identification and characterization of the culprit lesion plaque morphologyConservative pharmacologic treatment without revascularization might be appropriate in some patients with an intact fibrous cap