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Review
. 2020 May 28;22(6):21.
doi: 10.1007/s11883-020-00839-7.

Acute Coronary Syndrome with Non-ruptured Plaques (NONRUPLA): Novel Ideas and Perspectives

Marianna Leopoulou  1 , Vasiliki C Mistakidi  1 , Evangelos Oikonomou  2 , George Latsios  1 , Spyridon Papaioannou  1 , Spyridon Deftereos  1 , Gerasimos Siasos  1 , Alexis Antonopoulos  1 , George Charalambous  1 , Dimitris Tousoulis  1
Affiliations
Review

Acute Coronary Syndrome with Non-ruptured Plaques (NONRUPLA): Novel Ideas and Perspectives

Marianna Leopoulou et al. Curr Atheroscler Rep. .

Abstract

Purpose of review: In this review article, we focus on the mechanisms and features of acute coronary syndromes (ACS) with no ruptured plaque (NONRUPLA) highlighting the uncertainties over diagnostic evaluation and treatment.

Recent findings: The most common cause of ACS is obstruction due to atherosclerotic plaque ruptured or erosion. In 14% of patients who present in the Emergency Department as myocardial infarction, the final diagnosis is ACS with NONRUPLA. Although the clinical presentation of NONRUPLA may mimic myocardial infarction, the underlying pathogenesis is different, and it may guide therapeutic approaches and overall prognosis that vary according to etiology. The possible mechanisms of ACS with NONRUPLA are coronary embolism, acute dissection of the aorta or coronary artery, vasospasm, microvascular dysfunction, the imbalance between oxygen demand and supply, coronary trauma and stent complications, direct cellular toxicity and damage, Takotsubo syndrome, and myocardial infarction with non-obstructive coronary arteries (MINOCA).

Keywords: Acute coronary syndrome with no ruptured plaque; Coronary artery spasm; Myocardial infarction; Takotsubo syndrome.

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