Reith S, Milzi A, Lemma ED, et al. - Researchers investigated the role of intrinsic calcification angle (ICA)—the angle externally projected by a vascular calcification—as a new characteristic of coronary plaque vulnerability in patients with type 2 diabetes. From 56 patients with stable coronary artery disease (CAD) and from 36 patients with acute coronary syndrome (ACS), they determined ICA in 219 calcifications and 143 calcifications, respectively, using optical coherence tomography. ACS vs stable CAD patients had lower minimal and mean ICA. Very good diagnostic efficiency for ACS prediction was displayed by mean ICA; determinants of ICA < 175.9° were younger age, male sex, lower HDL-cholesterol and ACS. Increased stress on a lesion’s fibrous cap was found to be induced by lower ICA, as confirmed in finite elements analysis; this impact was potentiated in more superficial calcifications and adds to the destabilizing role of smaller calcifications. This study generated the first-ever clinical and mechanistic data supporting the role of ICA as a novel feature of coronary plaque vulnerability.