Pan W, Sun M, Wu J, et al. - In this study with two parallel cohorts, researchers investigated the links between specific plasma ceramides (Cer) levels and culprit plaque morphology in patients experiencing ST-segment elevation myocardial infarction (STEMI). Experts screened 100 consecutive patients with STEMI as discovery cohort. They separately screened 30 normal donors, 30 stable angina pectoris (SAP) and 315 STEMI patients in the validation cohort. Emergency percutaneous intervention and optical coherence tomography for culprit plaque were performed in all STEMI patients. STEMI patients were grouped into plaque rupture (PR) and plaque erosion (PE) group based on established diagnostic criteria. Higher plasma Cer(d18:1/16:0), Cer(d18:1/18:0), Cer(d18:1/24:1) and Cer(d18:1/24:0) levels were detected in STEMI patients vs normal donors and SAP patients. STEMI patients with PR vs with PE were found to have significantly higher plasma Cer levels. With rising tertiles of plasma Cer, the frequency of PR increased. Findings revealed new, positive and independent links between plasma Cer levels and the presence of PR, indicating a likely role of plasma Cer as potential biomarkers for PR to improve risk stratification.