Editorial on the "Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial," which studied optimal medical treatment with or without percutaneous coronary intervention (PCI) for stable coronary disease.
In the Injury Theory, it's damage to the arterial endothelium, followed by platelet activation, then smooth muscle cell migration to injury, then macrophages, with resulting "foam cells." Engorged foam cells burst, starting the injury cycle all over again