Detection Of Vulnerable Plaques Research Articles

Diagnostic accuracy of carotid plaque instability by noninvasive imaging: a systematic review and meta-analysis.

There is increasing evidence that plaque instability in the extracranial carotid artery may lead to an increased stroke risk independently of the degree of stenosis. We aimed to determine diagnostic accuracy of vulnerable and stable plaque using noninvasive imaging modalities when compared to histology in patients with symptomatic and asymptomatic carotid atherosclerosis. Medline Ovid, Embase, Cochrane Library, and Web of Science were searched for diagnostic accuracy of noninvasive imaging modalities (CT, MRI, US) in the detection of 1) vulnerable/stable plaque, and 2) vulnerable/stable plaque characteristics, compared to histology. The quality of included studies was assessed by QUADAS-2 and univariate and bivariate random-effect meta-analyses were performed. We included 36 vulnerable and 5 stable plaque studies in the meta-analysis, and out of 211 plaque characteristics from remaining studies, we classified 169 as vulnerable and 42 as stable characteristics (28 CT, 120 MRI, 104 US characteristics). We found that MRI had high accuracy [90% (95% CI: 82-95%)] in the detection of vulnerable plaque, similar to CT [86% (95% CI: 76-92%); P > 0.05], whereas US showed less accuracy [80% (95% CI: 75-84%); P = 0.013]. CT showed high diagnostic accuracy in visualizing characteristics of vulnerable or stable plaques (89% and 90%) similar to MRI (86% and 89%; P > 0.05); however, US had lower accuracy (77%, P < 0.001 and 82%, P > 0.05). CT and MRI have a similar, high performance in detecting vulnerable carotid plaques, whereas US showed significantly less diagnostic accuracy. Moreover, MRI visualized all vulnerable plaque characteristics allowing for a better stroke risk assessment. PROSPERO ID CRD42022329690.

Noninvasive platelet membrane‐coated Fe3O4 nanoparticles identify vulnerable atherosclerotic plaques

AbstractVulnerable atherosclerotic plaques serve as the primary pathological basis for fatal cardiovascular and cerebrovascular diseases. The precise identification and treatment of these vulnerable plaques hold paramount clinical importance in mitigating the incidence of myocardial infarction and stroke. Nevertheless, the identification of vulnerable plaques within the diffuse atherosclerotic plaques dispersed throughout the systemic circulation continues to pose a substantial challenge in clinical practice. Double emulsion solvent evaporation method, specifically the water‐in‐oil‐in‐water (W/O/W) technique, was employed to fabricate Fe3O4‐based poly (lactic‐co‐glycolic acid) (PLGA) nanoparticles (Fe3O4@PLGA). Platelet membranes (PM) were extracted through hypotonic lysis, followed by ultrasound‐assisted encapsulation onto the surface of Fe3O4@PLGA, resulting in the formation of PM‐coated Fe3O4 nanoparticles (PM/Fe3O4@PLGA). Characterization of PM/Fe3O4@PLGA involved the use of dynamic light scattering, transmission electron microscopy, western blotting, and magnetic resonance imaging (MRI). A model of atherosclerotic vulnerable plaques was constructed by carotid artery coarctation and a high‐fat diet fed to ApoE−/− (Apolipoprotein E knockout) mice. Immunofluorescence and MRI techniques were employed to verify the functionality of PM/Fe3O4@PLGA. In this study, we initially synthesized Fe3O4@PLGA as the core material. Subsequently, a platelet membrane was employed as a coating for the Fe3O4@PLGA, aiming to enable the detection of vulnerable atherosclerotic plaques through MRI. In vitro, PM/Fe3O4@PLGA not only exhibited excellent biosafety but also showed targeted collagen characteristics and MR imaging performance. In vivo, the adhesion of PM/Fe3O4@PLGA to atherosclerotic lesions was confirmed in a mouse model of vulnerable atherosclerotic plaques. Simultaneously, PM/Fe3O4@PLGA as a novel contrast agent for MRI has shown effective identification of vulnerable atherosclerotic plaques. In terms of safety profile in vivo, PM/Fe3O4@PLGA has not demonstrated significant organ toxicity or inflammatory response in the bloodstream. In this study, we successfully developed a platelet‐membrane‐coated nanoparticle system for the targeted delivery of Fe3O4@PLGA to vulnerable atherosclerotic plaques. This innovative system allows for the visualization of vulnerable plaques using MRI, thereby demonstrating its potential for enhancing the clinical diagnosis of vulnerable atherosclerotic plaques.

Multivessel disease in patient with acute myocardial infarction: current treatment strategies and future perspectives

Patients who present with acute myocardial infarction (AMI) often suffer from coronary multivessel disease (MVD). This condition is associated with an increased mortality rate; it is, therefore, important to improve clinical outcomes through appropriate treatment strategies. Over the past decades, extensive research in AMI and MVD patients has consistently shown that complete revascularization is superior to treatment of the only culprit lesion. Another controversial issue concerns the most appropriate timing for percutaneous coronary intervention in non-culprit lesions. Fractional flow reserve (FFR) is considered the best method for identifying ischemic coronary lesions in the context of acute coronary syndromes, but the detection of vulnerable plaques in non-culprit vessels could further improve clinical outcomes. Intravascular imaging goes beyond physiology and it is potentially useful to recognize patients who are vulnerable, despite negative FFR. Therefore, we analyzed the most relevant studies that have investigated the relationship between physiological indexes and plaque vulnerability. However, ongoing trials aim to clarify how coronary physiology can be combined with the benefits of intracoronary imaging.

A parametric study of the effect of 3D plaque shape on local hemodynamics and implications for plaque instability.

The vast majority of heart attacks occur when vulnerable plaques rupture, releasing their lipid content into the blood stream leading to thrombus formation and blockage of a coronary artery. Detection of these unstable plaques before they rupture remains a challenge. Hemodynamic features including wall shear stress (WSS) and wall shear stress gradient (WSSG) near the vulnerable plaque and local inflammation are known to affect plaque instability. In this work, a computational workflow has been developed to enable a comprehensive parametric study detailing the effects of 3D plaque shape on local hemodynamics and their implications for plaque instability. Parameterized geometric 3D plaque models are created within a patient-specific coronary artery tree using a NURBS (non-uniform rational B-splines)-based vascular modeling pipeline. Realistic blood flow features are simulated by using a Navier-Stokes solver within an isogeometric finite-element analysis framework. Near wall hemodynamic quantities such as WSS and WSSG are quantified, and vascular distribution of an inflammatory marker (VCAM-1) is estimated. Results show that proximally skewed eccentric plaques have the most vulnerable combination of high WSS and high positive spatial WSSG, and the presence of multiple lesions increases risk of rupture. The computational tool developed in this work, in conjunction with clinical data, -could help identify surrogate markers of plaque instability, potentially leading to a noninvasive clinical procedure for the detection of vulnerable plaques before rupture.

Osteopontin targeted non-invasive nanoprobes with amplified surface plasmon resonance for photothermally enhanced multimodal precision imaging of vulnerable atherosclerotic plaques

Effective strategies for accurate differentiation of the vulnerable atherosclerosis (AS) plaques at molecular level for clinical diagnosis have yet been developed. Herein, a versatile SAmOCP nanoprobe, is constructed by sealing up the multinuclear gold self-assembled nanospheres by hollow mesoporous silicon shell and then decorating the surfaces with Chlorine e6 (Ce6)-conjugated osteopontin antibody (OPN Ab), followed by filling the internal cavity with perfluoropentane (PFP) for precise in vivo targeting and multi-modal imaging of the vulnerable AS plaques. SAmOCP nanoprobes actively recognize the foam cells and specifically target the vulnerable AS plaques in vivo. Relying on the exceptional photo-to-heat conversion properties resulting from enhanced localized surface plasmon resonance (LSPR) effects of Au self-assembled particles, the encapsulated liquid PFP could transform into abundant microbubbles when AS plaque-rich regions were overheated by 808-nm laser irradiation, enabling hyperthermia-enhanced microbubbles generation, thereby endowing nanoprobes with significantly enhanced ultrasonic imaging capacity. SAmOCP nanoprobes exhibit a triple-modality diagnostic efficacy of ultrasound/fluorescence/photothermal imaging for in vivo precise detection of vulnerable AS plaques at molecular level. Together, SAmOCP nanoprobes overcome the difficulty in identifying the vulnerable AS plaque for clinic practice, holding great promise for vulnerable AS diagnosis.

Emerging nanomaterials to enhance electrochemical impedance spectroscopy for biomedical applications

Over the last few decades, electrical impedance-based sensors have been investigated for clinical translation to detect changes in tissue conductivities, including cardiac output and pulmonary function. Recently, electrochemical impedance spectroscopy (EIS) provides metabolic measurements that occur at the electrode-tissue interface, and the 3-D EIS can be reconstructed to generate electrical impedance tomography (EIT) for detecting the impedimetric properties of the vascular wall or fatty liver disease. In both EIS and EIT applications, the electrochemical properties of the interface electrodes are essential to address the signal-to-noise ratio or sensitivity of measurements in the biological environment. To enhance the conductive properties, we will survey a series of carbon-based nanomaterials as the emerging candidates for coating the electrodes of bioimpedance sensors. In this review, we will provide a theoretical background on impedance-based measurements and highlight the current state of EIS and EIT, including their applications for cancer screening and detection of vulnerable atherosclerotic plaques. Next, we will focus on the strengths of different nanomaterials when used as an electrode coating to optimize charge transfer across the electric double layers and to enhance measurement sensitivity. We will also identify some unmet clinical needs, such as the ability to adapt to different hemodynamic conditions and blood vessel geometries, that can be realized by the novel biomaterials for the future EIS-based sensors.

Artificial Intelligence in Symptomatic Carotid Plaque Detection: A Narrative Review

Identifying atherosclerotic disease is the mainstay for the correct diagnosis of the large artery atherosclerosis ischemic stroke subtype and for choosing the right therapeutic strategy in acute ischemic stroke. Classification into symptomatic and asymptomatic plaque and estimation of the cardiovascular risk are essential to select patients eligible for pharmacological and/or surgical therapy in order to prevent future cerebral ischemic events. The difficulties in a “vulnerability” definition and the methodical issues concerning its detectability and quantification are still subjects of debate. Non-invasive imaging studies commonly used to detect arterial plaque are computed tomographic angiography, magnetic resonance imaging, and ultrasound. Characterization of a carotid plaque type using the abovementioned imaging modalities represents the basis for carotid atherosclerosis management. Classification into symptomatic and asymptomatic plaque and estimation of the cardiovascular risk are essential to select patients eligible for pharmacological and/or surgical therapy in order to prevent future cerebral ischemic events. In this setting, artificial intelligence (AI) can offer suggestive solutions for tissue characterization and classification concerning carotid artery plaque imaging by analyzing complex data and using automated algorithms to obtain a final output. The aim of this review is to provide overall knowledge about the role of AI models applied to non-invasive imaging studies for the detection of symptomatic and vulnerable carotid plaques.

A simulation framework for pulse wave and vector flow imaging using fluid–structure interaction and FIELD-II simulations

Pulse Wave Imaging (PWI) utilizes ultrasound elasticity imaging and normalized cross-correlation (NCC) tracking pulse-induced arterial wall distension propagations to perform localized pulse wave velocity and assess arterial compliance mapping for the early detection of vulnerable carotid plaques. At the same time, Vector Flow Imaging (VFI) using a singular value decomposition filter and NCC with axially and laterally shifted axial kernels provides blood flow information. In this study, fluid–structure interaction (FSI) simulations (FEBio) were integrated with FIELD-II ultrasound imaging simulations to optimize both PWI and VFI for simultaneous estimation of compliance and flow in structures of variable vessel geometry and plaque stiffness at distinct ultrasound parameters. The spatiotemporal maps of wall distension rate between FSI ground truth and PWI method were in excellent agreement (r2 = 0.968–0.982) at plane wave angles compounding at (−1°, 0, 1°) and NCC window size of 7 wavelengths in both straight and 87% stenotic vessel geometries. Similar agreement was found in 2D blood flow velocity estimation between FSI ground truth and VFI with a maximum correlation of 0.9464 at the systolic upstroke and r2 of 0.7426 at the angles of (−2°, 0, 2°) and NCC window size of 60 wavelengths. Overall, the framework presented herein allowed PWI and VFI technique validation and optimization prior to in vivo application.

A Coronary CT Angiography Radiomics Model to Identify Vulnerable Plaque and Predict Cardiovascular Events.

Background A noninvasive coronary CT angiography (CCTA)-based radiomics technique may facilitate the identification of vulnerable plaques and patients at risk for future adverse events. Purpose To assess whether a CCTA-based radiomic signature (RS) of vulnerable plaques defined with intravascular US was associated with increased risk for future major adverse cardiac events (MACE). Materials and Methods In a retrospective study, an RS of vulnerable plaques was developed and validated using intravascular US as the reference standard. The RS development data set included patients first undergoing CCTA and then intravascular US within 3 months between June 2013 and December 2020 at one tertiary hospital. The development set was randomly assigned to training and validation sets at a 7:3 ratio. Diagnostic performance was assessed internally and externally from three tertiary hospitals using the area under the curve (AUC). The prognostic value of the RS for predicting MACE was evaluated in a prospective cohort with suspected coronary artery disease between April 2018 and March 2019. Multivariable Cox regression analysis was used to evaluate the RS and conventional anatomic plaque features (eg, segment involvement score) for predicting MACE. Results The RS development data set included 419 lesions from 225 patients (mean age, 64 years ± 10 [SD]; 68 men), while the prognostic cohort included 1020 lesions from 708 patients (mean age, 62 years ± 11; 498 men). Sixteen radiomic features, including two shape features and 14 textural features, were selected to build the RS. The RS yielded a moderate to good AUC in the training, validation, internal, and external test sets (AUC = 0.81, 0.75, 0.80, and 0.77, respectively). A high RS (≥1.07) was independently associated with MACE over a median 3-year follow-up (hazard ratio, 2.01; P = .005). Conclusion A coronary CT angiography-derived radiomic signature of coronary plaque enabled the detection of vulnerable plaques that were associated with increased risk for future adverse cardiac outcomes. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by De Cecco and van Assen in this issue.

Cerium fluoride nanoparticles as a theranostic material for optical imaging of vulnerable atherosclerosis plaques

AbstractAtherosclerosis (AS) is a chronic progressive vascular disease, which can bring on a threat against the health. The eruption of unstable arteriosclerosis plaques has been linked to heart attacks and strokes. The accumulation of foamy macrophages initiates and evolves atherosclerotic plaques, which can be a good target for identifying vulnerable plaques. CD36 and OPN overexpress in foamy macrophages surface, which have a preferable relation with plaque disruption. Furthermore, we choose Yb ions and Tm ions as doping ions and Ce fluoride as matrix of luminescent materials and prepare upconversion luminescent nanoparticles. With the modification of CD36 antibody and OPN antibody, this material can target macrophages in arteriosclerosis plaques. As‐prepared nanoparticles (CeF3:Yb,Tm@SiO2–CD36/OPN) can be excited by near‐infrared light with deep tissue penetration, while emitting strong blue light to image arteriosclerosis plaques. In brief, this study provides a new upconversion luminescent material for the identification and detection of vulnerable atherosclerosis plaques.

Arterial myeloperoxidase in the detection and treatment of vulnerable atherosclerotic plaque: a new dawn for an old light.

Intracellular myeloperoxidase (MPO) plays a specific role in the innate immune response; however, upon release into the extracellular space in the setting of inflammation, drives oxidative tissue injury. Extracellular MPO has recently been shown to be abundant in unstable atheroma and causally linked to plaque destabilization, erosion, and rupture, identifying it as a potential target for the surveillance and treatment of vulnerable atherosclerosis. Through the compartmentalization of MPO's protective and deleterious effects, extracellular MPO can be selectively detected using non-invasive molecular imaging and targeted by burgeoning pharmacotherapies. Given its causal relationship to plaque destabilization coupled with an ability to preserve its beneficial properties, MPO is potentially a superior translational inflammatory target compared with other immunomodulatory therapies and imaging biomarkers utilized to date. This review explores the role of MPO in plaque destabilization and provides insights into how it can be harnessed in the management of patients with vulnerable atherosclerotic plaque.

Detection of Vulnerable Coronary Plaques Using Invasive and Non-Invasive Imaging Modalities.

Acute coronary syndrome (ACS) mostly arises from so-called vulnerable coronary plaques, particularly prone for rupture. Vulnerable plaques comprise a specific type of plaque, called the thin-cap fibroatheroma (TFCA). A TCFA is characterized by a large lipid-rich necrotic core, a thin fibrous cap, inflammation, neovascularization, intraplaque hemorrhage, microcalcifications or spotty calcifications, and positive remodeling. Vulnerable plaques are often not visible during coronary angiography. However, different plaque features can be visualized with the use of intracoronary imaging techniques, such as intravascular ultrasound (IVUS), potentially with the addition of near-infrared spectroscopy (NIRS), or optical coherence tomography (OCT). Non-invasive imaging techniques, such as computed tomography coronary angiography (CTCA), cardiovascular magnetic resonance (CMR) imaging, and nuclear imaging, can be used as an alternative for these invasive imaging techniques. These invasive and non-invasive imaging modalities can be implemented for screening to guide primary or secondary prevention therapies, leading to a more patient-tailored diagnostic and treatment strategy. Systemic pharmaceutical treatment with lipid-lowering or anti-inflammatory medication leads to plaque stabilization and reduction of cardiovascular events. Additionally, ongoing studies are investigating whether modification of vulnerable plaque features with local invasive treatment options leads to plaque stabilization and subsequent cardiovascular risk reduction.

Potential of optical coherence tomography and intravascular ultrasound in the detection of vulnerable plaques in coronary arteries

Intravascular imaging of vulnerable plaques in vivo has great potential for predicting coronary events. Currently, there are several methods of intravascular imaging, which make it possible to verify the components of the plaque and, accordingly, its vulnerability. The most common are virtual-histology intravascular ultrasound and optical coherence tomography. Several studies have shown that these imaging techniques can stratify the risk of adverse cardiovascular events, as well as assess the effectiveness of drug therapy. This article will describe the advantages and disadvantages of intravascular ultrasound and optical coherence tomography in identifying vulnerable coronary lesions.

Correcting Pseudo Labels with Label Distribution for Unsupervised Domain Adaptive Vulnerable Plaque Detection.

Pseudo-label-based unsupervised domain adaptation (UDA) has increasingly gained interest in medical image analysis, aiming to solve the problem of performance degradation of deep neural networks when dealing with unseen data. Although it has achieved great success, it still faced two significant challenges: improving pseudo labels' precision and mitigating the effects caused by noisy pseudo labels. To solve these problems, we propose a novel UDA framework based on label distribution learning, where the problem is formulated as noise label correcting and can be solved by converting a fixed categorical value (pseudo labels on target data) to a distribution and iteratively update both network parameters and label distribution to correct noisy pseudo labels, and then these labels are used to re-train the model. We have extensively evaluated our framework with vulnerable plaques detection between two IVOCT datasets. Experimental results show that our UDA framework is effective in improving the detection performance of unlabeled target images.

Vulnerable atherosclerotic plaque features: findings from coronary imaging.

Pathological studies have suggested that features of vulnerable atherosclerotic plaques likely to progress and lead to acute cardiovascular events have specific characteristics. Given the progress of intravascular coronary imaging technology, some large prospective studies have detected features of vulnerable atherosclerotic plaques using these imaging modalities. However, the rate of cardiovascular events, such as acute coronary syndrome, has been found to be considerably reduced in the limited follow-up period available in the statin era. Additionally, not all disrupted plaques lead to thrombus formation with clinical presentation. If sub-occlusive or occlusive thrombus formation does not occur, a thrombus on a disrupted plaque will organize without any symptoms, forming a “healed plaque”. Although vulnerable plaque detection using intracoronary imaging is focused on “thin-cap fibroatheroma” leading to plaque rupture, superficial plaque erosion is increasingly recognized; however, the underlying mechanism of thrombus formation on eroded plaques is not well understood. One of intravascular imaging, optical coherence tomography (OCT) has the highest image resolution and has enabled detailed characterization of the plaque in vivo. Here, we reviewed the status and limitations of intravascular imaging in terms of detecting vulnerable plaque through mainly OCT studies. We suggested that vulnerable plaque should be reconsidered in terms of eroded plaque and healed plaque and that both plaque and circulating blood should be assessed in greater detail accordingly.

Optical coherence tomography and vulnerable plaque detection: how far are we willing to stray from true histology?

Optical coherence tomography and vulnerable plaque detection: how far are we willing to stray from true histology?

Circulating Biomarkers Reflecting Destabilization Mechanisms of Coronary Artery Plaques: Are We Looking for the Impossible?

Despite significant strides to mitigate the complications of acute coronary syndrome (ACS), this clinical entity still represents a major global health burden. It has so far been well-established that most of the plaques leading to ACS are not a result of gradual narrowing of the vessel lumen, but rather a result of sudden disruption of vulnerable atherosclerotic plaques. As most of the developed imaging modalities for vulnerable plaque detection are invasive, multiple biomarkers were proposed to identify their presence. Owing to the pivotal role of lipids and inflammation in the pathophysiology of atherosclerosis, most of the biomarkers originated from one of those processes, whereas recent advancements in molecular sciences shed light on the use of microRNAs. Yet, at present there are no clinically implemented biomarkers or any other method for that matter that could non-invasively, yet reliably, diagnose the vulnerable plaque. Hence, in this review we summarized the available knowledge regarding the pathophysiology of plaque instability, the current evidence on potential biomarkers associated with plaque destabilization and finally, we discussed if search for biomarkers could one day bring us to non-invasive, cost-effective, yet valid way of diagnosing the vulnerable, rupture-prone coronary artery plaques.

Cardiovascular Imaging Techniques for Detection of Vulnerable Plaques

Abstract Various cardiovascular imaging techniques were developed for the detection of vulnerable atherosclerotic plaques, hoping to be able to predict a cardiovascular event. Plaque vulnerability results from compound pathophysiological mechanisms that lead to structural and morphological changes in lesions. The aim of this review is to present the most recent techniques for the assessment of vulnerable coronary plaques such as cardiac computed tomography angiography (CCTA), optical coherence tomography, or virtual histology intravascular ultra-sound, based on literature data from the last 3 years. CCTA permits direct visualization of the intravascular lumen, together with characterization of the arterial wall. Recent studies maintain that low-attenuation plaques, spotty calcifications, positive vessel remodeling, and the napkin-ring sign are considered main markers of plaque vulnerability and instability. Emerging analytical techniques, such as machine learning or radiomics, will probably demonstrate useful as an auxiliary diagnostic tool for vulnerable plaque detection. The data from the two imaging techniques together provide useful information, especially in patients undergoing a PCI procedure for an acute coronary syndrome. Invasive and noninvasive imaging techniques are able to deliver a large amount of scientific data to assess vulnerable coronary atheromatous plaques. Recent studies demonstrated that information defined by the two techniques is complementary, and using both methods is essential for adequate diagnosis, therapeutic strategy, and prognostic assessment.

The Napkin-Ring Sign – the Story Behind Invasive Coronary Angiography

Abstract Coronary artery disease (CAD) represents one of the leading causes of morbidity and mortality across Europe. Most of the patients do not experience any warning sign before the coronary event develops, therefore screening this group of patients is essential to prevent major cardiac events. Coronary computed tomography angiography (CCTA) offers a noninvasive approach of the coronary arteries, providing information not only on the presence and severity of the coronary stenosis, but is also able to characterize the structure of the coronary wall. CCTA allows complex evaluation of the extension of CAD, and by assessing the structure of the atherosclerotic plaque, it can identify its degree of vulnerability. The napkin-ring sign (NRS) represents a ring-like attenuation of the non-calcified portion of the coronary lesion and has a high specificity (96–100%) for the identification of thin cap fibroatheroma (TCFA) or culprit lesion in acute coronary syndromes (ACS). It is also an independent predictor for ACS events and the strongest predictor for future ACS. Modern CCTA can provide submillimeter isotropic spatial resolution. Thus, CT attenuation-based tissue interpretation enables the assessment of total coronary plaque burden and individual plaque components, with a similar accuracy as intravascular ultrasoud-based investigations. This review aims to present the important role of CCTA as a potent screening tool for patients with CAD, and the current evidences in the detection and quantification of vulnerable plaques.

Optical coherence tomography detection of vulnerable plaques at high risk of developing acute coronary syndrome.

The ability of optical coherence tomography (OCT) to detect plaques at high risk of developing acute coronary syndrome (ACS) remains unclear. The aim of this study was to evaluate the association between non-culprit plaques characterized as both lipid-rich plaque (LRP) and thin-cap fibroatheroma (TCFA) by OCT and the risk of subsequent ACS events at the lesion level. In 1378 patients who underwent OCT, 3533 non-culprit plaques were analysed for the presence of LRP (maximum lipid arc > 180°) and TCFA (minimum fibrous cap thickness < 65 μm). The median follow-up period was 6 years [interquartile range (IQR): 5-9 years]. Seventy-two ACS arose from non-culprit plaques imaged by baseline OCT. ACS was more often associated with lipidic plaques that were characterized as both LRP and TCFA vs. lipidic plaques that did not have these characteristics [33% vs. 2%, hazard ratio 19.14 (95% confidence interval: 11.74-31.20), P < 0.001]. The sensitivity and specificity of the presence of both LRP and TCFA for predicting ACS was 38% and 97%, respectively. A larger maximum lipid arc [1.01° (IQR: 1.01-1.01°)], thinner minimum fibrous cap thickness [0.99 μm (IQR: 0.98-0.99 μm)], and smaller minimum lumen area [0.78 mm2 (IQR: 0.67-0.90 mm2), P < 0.001] were independently associated with ACS. Non-culprit plaques characterized by OCT as both LRP and TCFA were associated with an increased risk of subsequent ACS at the lesion level. Therefore, OCT might be able to detect vulnerable plaques.