Iannaccone M, et al. - Researchers assessed the clinical impact of the culprit plaque features assessed by optical coherence tomography (OCT) in patients with the acute coronary syndrome (ACS). In nine European centres, the OCT-FORMIDABLE register enrolled retrospectively all consecutive patients who perform OCT on culprit plaque in patients with ACS. They enrolled two-hundred and nine patients in this study. The present data indicated that culprit plaque rupture (CPR) and the presence of necrotic core with macrophage infiltrations (NCMI) were independent predictors of worse outcome. They reported that patients with CPR seem to benefit more from an intensive therapy, both from a pharmacological and interventional point of view.