Physiological predictors of acute coronary syndromes: emerging insights from the plaque to the vulnerable patient

Thomas J. Ford, Colin Berry, Bernard De Bruyne, Andy S. C. Yong, Peter Barlis, William F. Fearon, Martin K. C. Ng*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

40 Citations (Scopus)


In this review, the authors explore the evolving evidence linking physiological assessment of coronary artery disease with plaque progression and vulnerability. Reducing adverse clinical events remains the ultimate goal for diagnostic tests, and this review highlights evidence supporting the prognostic value of physiological metrics in predicting outcomes. Historical and contemporary studies support synergy among lesion severity, ischemia, plaque vulnerability, and patient prognosis. Ischemia contributes to clinical events through association with plaque burden, but this review addresses the emerging concept that it associates with atherothrombosis via disturbed lesion hemodynamics. Biomechanical pathophysiological forces including endothelial shear stress—the frictional force generated by blood flow on the vessel wall—are increasingly linked with atherogenesis, vulnerable plaque morphology, and platelet and leukocyte activation. The authors conclude by transitioning from the model of the vulnerable plaque to the concept of the “vulnerable patient,” looking more broadly at physiological contributors to Virchow's triad underpinning acute coronary syndrome.

Original languageEnglish
Pages (from-to)2539-2547
Number of pages9
JournalJACC: Cardiovascular Interventions
Issue number24
Publication statusPublished - 26 Dec 2017
Externally publishedYes


  • acute coronary syndromes(s)
  • coronary physiology
  • endothelial shear stress
  • mechanisms of atherosclerosis
  • plaque vulnerability


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