The role of high-risk plaque in refining cardiovascular event prediction

Purpose of review High-risk plaque (HRP) features are commonly observed in patients with acute coronary syndromes (ACS); however, their individual predictive value remains limited. This review explores the importance of integrating anatomical and physiological assessments to enhance risk stratification and optimize therapeutic decision-making. Recent findings Studies have indicated that combining HRP evaluation with hemodynamic assessment significantly improves prognostic accuracy, particularly in guiding revascularization strategies. Although the interaction between HRP and inflammatory biomarkers remains incompletely understood, specific plaque characteristics, such as positive remodeling, have demonstrated consistent associations with lesion-specific inflammation. Furthermore, emerging evidence suggests that hemodynamic stress plays a crucial role in plaque progression and disruption, reinforcing the need for a more comprehensive approach. Summary A refined strategy that incorporates plaque burden, functional significance, and vascular inflammation is promising for improving cardiovascular risk prediction. By integrating these elements, HRP assessment may improve patient outcomes by optimizing preventive interventions and mitigating the progression of atherosclerotic disease.