Perspective:

Multiple studies have demonstrated that HRP features on CTA are associated with an increased risk of future acute coronary syndromes, although the absolute difference in risk is relatively small, and there are limited data evaluating the future risk of individual plaques. This study examined a large cohort of patients with both CTA and OCT, and systematically examined vulnerable plaque features on OCT associated with specific HRP features identified by CTA. The study finds that each HRP feature on CTA is associated with one or more vulnerable plaque features on OCT, and that an increased number of HRP features on CTA is associated with a higher prevalence of vulnerable plaque features on OCT.

As previously reported in other studies, the authors also find that HRP on CTA is associated with increased adverse events. This study helps us understand the relationship between specific high-risk CTA and OCT findings, using the higher-resolution imaging of OCT to better define plaque characteristics seen on CTA. As seen in prior studies, the authors find that HRP on CTA may identify patients at increased risk of adverse events. However, the clinical utility of HRP features on CTA remains unclear. While HRP features may identify patients at increased risk of adverse events, it remains unclear whether changes in treatment are an effective way to lower this potential risk.