Seeing is believing

Risk scores are essential tools in cardiovascular medicine for stratifying patients’ risk of recurrent events and guiding secondary prevention strategies. One of the well-validated scores in large cohorts of patients after myocardial infarction (MI) is the Thrombolysis in Myocardial Infarction Risk Score for Secondary Prevention (TRS-2P)1. Intravascular imaging has become a cornerstone in assessing coronary plaque morphology. Among the available modalities, optical coherence tomography (OCT) enables the precise visualisation of features associated with plaque vulnerability, such as thin-cap fibroatheroma (TCFA), a large lipid core, or plaque rupture2. Previous studies demonstrated that OCT identified the presence of high-risk plaque (HRP) in up to 48% of non-culprit arteries in patients presenting with acute coronary syndrome (ACS)345. Conversely, physiological lesion assessment using either conventional or angiography-based physiology appeared to only have a limited negative predictive value as HRP was determined in up to 31% of fractional flow reserve (FFR)-negative non-culprit lesions46. Despite the clear benefits of OCT, its use in routine clinical practice remains limited, primarily due to factors such as challenges in reimbursement and lack...