The quiescent volcanoes that don't harm anymore

Cardiologists examine the coronary vessels much like geologists study volcanoes – by observing their continuous structural evolution and confronting similar questions: is the volcano a dormant Mauna Kea or an active Etna?

Plaque ulceration is a traumatic event in the course of atherosclerosis that most often progresses silently1. A long-standing question has been whether these dangerous phases of plaque destabilisation are associated with worse clinical prognosis. Several earlier studies – although not supported by robust evidence regarding the risk associated with these signs of prior plaque ulceration – have used non-culprit plaque rupture (NCPR) as a marker of high risk and investigated its prognostic significance without being able to reach definitive conclusions23.

In this issue of EuroIntervention, Zhao et al4 assess the prognostic impact of NCPR in an optical coherence tomography (OCT) study of the three major coronary vessels, for which their efforts should be commended. The authors examined, with 3-vessel OCT, a total of 930 ST-segment elevation myocardial infarction patients with 3,660 non-culprit lesions. NCPR was detected in 165 patients (18% of cases). During a median 4.1-year...