Which of the following characteristics of the atheroma

A 60-year-old Caucasian male presents to the emergency room with chest pain. Coronary angiography reveals significant stenosis of the left anterior descending (LAD) artery. Which of the following characteristics of the atheroma is the most important physiologically plausible predictor of myocardial necrosis in this patient?

1.Cholesterol crystal presence
2.Rate of formation
3.Calcium content
4.Presence of cytokines
5.Amount of foam cells

sol:
A slow-forming atheroma allows for formation of collateral circulation, thereby lowering the chance of myocardial infarction (MI) and necrosis.
The most important factor as to whether or not a coronary artery plaque will cause an ischemic MI, is the rate in which the artery is occluded. If occluded slowly, there is time for the development of new arterial collaterals which are protective from myocardial ischemia. These collateral vessels provide blood flow to hypoperfused area of cardiac tissue distal to the point of occlusion. Conversely, with rapid coronary occlusion, there is not enough time for collateral development and thus myocardial ischemia is inevitable.
Hall et al. discuss the various secondary preventative methods employed in a patient with coronary artery disease (CAD). In patients who have had an MI or a procedure for revascularization, secondary prevention of CAD includes risk factor reduction, medical therapy, and surgical revascularization in the form of coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). In this subset of patients, these efforts effectively reduce mortality, decrease subsequent cardiac events, and improve overall quality of life.
Hansson describes plaque rupture and endothelial erosion as the major causes of coronary thrombosis, with plaque rupture considered to be the more important pathological cause. When a plaque ruptures, it exposes prothombotic material from the core of the plaque. Ruptures happen often when the fibrous cap is thin or slightly degredated. Therefore, the thickness of the cap is an important determinant of the risk of myocardial ischemia and necrosis. The ruptured plaque and subsequent thrombus formation will elicit an acute coronary syndrome.
Illustration A depicts an overview image of coronary atherosclerosis. Illustration B shows the pathophysiology of the stages in the development of atherosclerotic disease.