April 25, 2026Journal of the American College of Cardiology
Pathology of the Vulnerable Plaque
Key result
Thin cap fibroatheromas, precursor lesions to acute plaque rupture, are characterized by a necrotic core with a fibrous cap <65 micrometers and are common in patients with high cholesterol.
Why the study?
To recognize the precursor lesion of ACS, such as thin cap fibroatheroma, to help advance understanding and potentially reduce the incidence of sudden coronary death.
Population
Patients with acute coronary syndromes (ACS) and sudden coronary death
Design
Review
Authors
Discussion
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Implication
TCFA morphology in nonobstructive lesions may inform ACS risk assessment; leaves open prospective imaging studies before practice change.
Key Points
- Identify the role of thin cap fibroatheromas as precursor lesions of acute coronary syndromes.
- Analyzed the characteristics of thin cap fibroatheromas associated with coronary thrombosis.
- Assessed the prevalence of other coronary lesions in patients presenting with acute myocardial infarction.
- Thin cap fibroatheromas observed in over 75% of acute myocardial infarction cases with a necrotic core area <3 mm2.
- Most TCFAs show less than 75% diameter stenosis but exhibit positive remodeling.
- Precursor lesions are commonly seen in patients with elevated total cholesterol and high sensitivity C-reactive protein levels.
Structured PICO
P
Population
Patients with acute coronary syndromes (ACS) and sudden coronary death
Recognizing the thin cap fibroatheroma as the precursor to plaque rupture is critical for identifying vulnerable plaques and potentially reducing the incidence of sudden coronary death.
Cite This Study
Virmani et al. (2006) conducted a review in Acute coronary syndromes. Thin cap fibroatheromas, precursor lesions to acute plaque rupture, are characterized by a necrotic core with a fibrous cap <65 micrometers and are common in patients with high cholesterol.