As most acute coronary syndromes occur due to plaque rupture with superimposed occlusive thrombosis at sites involving non-obstructive coronary narrowings [53-56], this concept might explain significant independent associations of ADMA with adverse outcome but not with indices of CAD severity (the presence of angiographically obstructive CAD [9] or Friesinger score [8]) upon multivariate adjustment for traditional risk factors, renal function and C-reactive protein in the previously cited reports on patients referred to coronary angiography [8,9]. Here, CRP is linked to acute coronary syndrome.