Emerging Insights into the Pathobiology of Acute Coronary Syndromes

Plaque rupture/erosion followed by thrombosis is the underlying cause of the most important clinical complications in the pathogenesis of acute coronary syndrome, stroke, and peripheral vascular diseases. Identifying early biomarkers of plaque presence and susceptibility to ulceration could be crucial in averting life-threatening events. As proteomic tools advance, large-scale technologies become increasingly valuable for deciphering pathways involved in atherosclerotic degeneration and discovering novel circulating markers useful as early diagnostic indicators or targets for innovative drug therapies. Several matrices including plasma, urine, microparticles, lipoproteins, atherosclerotic plaque extracts/secretomes, and thrombi have been investigated in recent decades to address these issues. Besides, proteomics has also been applied to different experimental models of atherosclerosis to gain further insights into the mechanisms influencing atherogenesis. This chapter provides an overview of the past two decades of omics applications searching for both circulating and tissue biomarkers of acute coronary syndromes. Key issues including plaque complexity, methodological approaches, sample selection, and availability will be discussed, alongside considerations for future directions.