Atherosclerosis and plaque disruption have a central pathological role in the majority of patients who present with an acute coronary syndrome (ACS), but non-atherosclerotic processes are also important contributors to a substantial number of ACS events and require different diagnostic and therapeutic strategies. In the absence of obstructive coronary artery disease, intravascular imaging techniques might be needed to delineate the underlying aetiology, together with a high index of suspicion for other important causes of ACS. In this Review, we discuss five non-atherosclerotic causes of ACS, including spontaneous coronary artery dissection, coronary artery embolism, vasospasm, myocardial bridging and stress-induced cardiomyopathy (Takotsubo syndrome). Important diagnostic findings, management strategies and prognostic data for these non-atherosclerotic mechanisms of ACS are reviewed.

中文翻译：

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急性冠状动脉综合征的非动脉粥样硬化原因。

在大多数患有急性冠脉综合征（ACS）的患者中，动脉粥样硬化和斑块破坏具有重要的病理作用，但是非动脉粥样硬化过程也是导致大量ACS事件的重要因素，因此需要不同的诊断和治疗策略。在没有梗阻性冠状动脉疾病的情况下，可能需要使用血管内成像技术来描述潜在的病因，以及对ACS其他重要原因的高度怀疑。在这篇综述中，我们讨论了ACS的五种非动脉粥样硬化原因，包括自发性冠状动脉夹层，冠状动脉栓塞，血管痉挛，心肌桥和应激性心肌病（Takotsubo综合征）。重要的诊断结果，