PERSPECTIVE Insights into the pathogenesis of acute ischemic

OVER THE LAST few years clinical/pathologic ob-servations and experimental investigation have led us to a better understanding of the pathogenetic factors leading to the acute coronary syndromes: unstable an-gina, myocardial infarction, and ischemic sudden death. The elegant pathologic studies of Falk ' and Da-vies and Thomas2 have emphasized that thrombus for-mation secondary to plaque rupture and fissuring in the atherosclerotic coronary artery play a major and fre-quent role in the acute coronary syndromes. Indeed, their observations and the observations of others have established that this pathologic phenomenon is a com-mon link between the three acute coronary syndromes in man.3 This review focuses on three areas of recent progress: (1) the interaction between platelets, throm