Pathologic correlates in stable coronary plaques. Traditional and novel insights from pathology

Coronary artery disease (CAD) remains the most common cause of death overall and is the leading cause of cardiovascular mortality worldwide 1. Although huge advances in medical therapy have been made within the last decades, the number of worldwide deaths due to CAD will further increase according to current forecasts 2. Based on the knowledge and understanding of CAD which cardiovascular research has provided over the last decades, patient care has made substantial progress in daily clinical practice. Although the implementation and further refinement of invasive treatment techniques have paved the way for revolutionary concepts especially in the setting of acute coronary syndromes, a true mortality benefit after percutaneous coronary intervention (PCI) of stable lesions has not been shown to date, which may partly be explained by incomplete understanding of atherosclerotic lesion progression underlying the symptomatic presentation of patients with CAD. Therefore, the following review focuses on traditional knowledge and novel concepts of stable atherosclerotic coronary plaque progression from a pathological point of view, to provide a foundation for future technological refinements and novel therapeutic approaches.

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