Possible Mechanisms of Coronary Artery Occlusion

Our knowledge of the mechanisms of coronary arterial occlusion is fragmentary but growing rapidly. Complex interactions among multiple factors may be important in precipitating spasm, altering coronary tone, and provoking occlusion. The specific could vary from time to time in the same patient and/or be different from patient to patient, perhaps depending on factors in the circulating blood, autonomic nervous system interactions and the status of coronary endothelium. Platelets, white cells, circulating and/or locally produced mediators, including prostaglandins, serotonin and histamine, may be involved in the process. The role of the endothelium may be very important. It is conceivable that endothelial dysfunction or disruption could be essential in the initiation of pathophysiological process resulting in occlusion. It was hoped that a single common mediator would be found to serve as a ‘final common path’ for coronary arterial occlusion, but no compound appears to be a leading candidate on the basis of the data currently available. Investigations into these mechanisms are among the most intriguing and important in cardiovascular medicine. The clinical implications and potential for therapeutic approaches based on a better understanding of these processes are exciting and important.