Iannaccone M, et al. - Researchers investigated the clinical significance of optical coherence tomography (OCT)-assessed culprit plaque features in 209 consecutive patients (mean age 60.1 ± 12.9 years, 19.1% were females) with acute coronary syndrome (ACS) from 9 European centres and enrolled retrospectively in the OCT-FORMIDABLE register. Overall, 55% cases presented with ST-elevation myocardial infarction. At OCT analysis, 71.8% patients had culprit plaque rupture (CPR), while 31.6% presented necrotic core with macrophage infiltrations (NCMI). Major adverse cardiovascular events (MACEs) were seen in 11% during follow-up (12.6 ± 14.5 months). Worse outcome was independently predicted by both CPR and the presence of NCMI. An intensive therapy seemed to be beneficial for patients with CPR.