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Acute coronary syndrome (ACS) consists of unstable angina, non-ST segment elevation myocardial infarction (NSTEMI), and STEMI. The pathology underlying ACS is acute thrombosis in a coronary artery, which is usually caused by plaque rupture in a mild stenotic lesion. A rupture-prone plaque is known as a vulnerable plaque (VP), although recently the definition of VP has been expanded to include rapidly progressive plaque. Although no single method can predict future cardiac events in mild stenotic lesions, there have been big advances in detecting VP, such as virtual histology-intravascular ultrasound and optical coherence tomography. These techniques look for thin cap fibroatheromas, which is the most common type of VP, characterized by a thin fibrous cap <65 μm, a large necrotic core, and marked macrophage infiltration of the fibrous cap. The recent concept of VP, the methods for detecting VP, and the treatment of VP are discussed.
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