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The appreciation of arterial remodeling (compensatory enlargement) has expanded attention beyond stenoses evident by angiography to encompass the biology of nonstenotic plaques. Revascularization effectively relieves ischemia, but we now recognize the need to attend to nonobstructive lesions as well. Aggressive management of modifiable risk factors reduces cardiovascular events and should accompany appropriate revascularization. We now recognize that disruption of plaques that may not produce critical stenoses causes many acute coronary syndromes (ACS). The disrupted plaque represents a \u201csolid-state\u201d stimulus to thrombosis. Alterations in circulating prothrombotic or antifibrinolytic mediators in the \u201cfluid phase\u201d of the blood can also predispose toward ACS. Recent results have established the multiplicity of \u201chigh-risk\u201d plaques and the widespread nature of inflammation in patients prone to develop ACS. These findings challenge our traditional view of coronary atherosclerosis as a segmental or localized disease. Thus, treatment of ACS should involve 2 overlapping phases: first, addressing the culprit lesion, and second, aiming at rapid \u201cstabilization\u201d of other plaques that may produce recurrent events. The concept of \u201cinterventional cardiology\u201d must expand beyond mechanical revascularization to embrace preventive interventions that forestall future events.<\/jats:p>","DOI":"10.1161\/circulationaha.105.537878","type":"journal-article","created":{"date-parts":[[2005,6,28]],"date-time":"2005-06-28T00:04:33Z","timestamp":1119917073000},"page":"3481-3488","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1559,"title":["Pathophysiology of Coronary Artery Disease"],"prefix":"10.1161","volume":"111","author":[{"given":"Peter","family":"Libby","sequence":"first","affiliation":[{"name":"From the Donald W. Reynolds Cardiovascular Clinical Research Center (P.L.), Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Mass, and the Department of Medicine (P.T.), Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Theroux","sequence":"additional","affiliation":[{"name":"From the Donald W. 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