Key messages

• Regional infarction is due to thrombosis in the subtending artery.

• Thrombi occur over plaques undergoing disruption.

• Plaques at risk of disruption have a high lipid and macrophage content.

• Cardiogenic shock is a complication of large infarcts.

• In cardiogenic shock further non-regional necrosis develops due to hypoperfusion.

• Cardiac rupture causes 10 per cent of infarct mortality.

• Transmural infarcts may expand and alter the long-term ventricular shape.

• Non-transmural infarcts do not expand.

• Non-transmural infarcts are associated with either prior collateral flow or re-establishment of antegrade flow within 6 h.

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