title: Contemporary invasive imaging modalities that identify and risk-stratify coronary plaques at risk of rupture.
abstract: Atherosclerotic plaque rupture is responsible for the majority of myocardial infarctions, with ruptured plaques exhibiting specific morphological features, including large lipid cores, thinner overlying fibrous caps and micro-calcifications. Contemporary imaging modalities are increasingly able to characterize plaques, potentially leading to the identification of precursor lesions that are at high risk of rupture. Observational studies using invasive imaging consistently find that plaques responsible for an acute coronary event display these high-risk morphological features, and recent prospective imaging studies have now established links between baseline plaque characteristics and future cardiovascular events. Despite these promising advances, subsequent overall event rates remain too low for clinical utility. Novel technologies are now required to refine and improve our ability to identify and risk-stratify lesions at risk of rupture, if plaque-based risk evaluation is ever to become reality.
authors.affiliation: Division of Cardiovascular Medicine, University of Cambridge, Level 6, ACCI, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Brown
authors.forename: Charis
authors.initials: C
authors.lastname: Costopoulos
authors.forename: Nick Ej
authors.initials: NE
authors.lastname: West
authors.forename: Martin R
authors.initials: MR
authors.lastname: Bennett
mesh_terms: D017546:Angioscopy / Q000379:methods; D017023:Coronary Angiography / Q000379:methods; D003327:Coronary Disease / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D058226:Plaque, Atherosclerotic / Q000175:diagnosis* / Q000473:pathology; D011446:Prospective Studies; D012306:Risk; D012421:Rupture; D018084:Ultrasonography, Interventional / Q000379:methods
keywords: angioscopy; coronary atherosclerosis; intravascular ultrasound; near-infrared spectroscopy; optical coherence tomography; virtual-histology intravascular ultrasound