Kanaya T, et al. - Coronary high-intensity plaques (HIPs) with a high plaque-to-myocardial signal intensity ratio (PMR) on non-contrast T1-weighted imaging in patients with stable coronary artery disease (CAD) are associated with future coronary events. In this correlative optical coherence tomography (OCT) study, the morphologic substrate of HIP was characterized. A significant association between HIP- and OCT-derived healed plaque rupture and large lipid core was demonstrated. The HIP group versus non-HIP group had a significantly higher prevalence of lipid-rich plaque, macrophage accumulation, cholesterol crystals, and healed plaque rupture. No significant differences were observed for the presence of thin cap fibroatheromas, intracoronary thrombi, and plaque rupture between the two groups.