Case example of a patient with a lipid-rich and large plaque in the left anterior descending (LAD) artery. The patient is an 83-year-old man with a past medical history of hyperlipidaemia, type 1 diabetes mellitus, and hypothyroidism, and he is a former smoker. Index cardiac catheterization with index angiography in 2014 showed stenosis of the left main and LAD arteries (A). About a year later, the patient presented to the emergency room complaining of ‘chest discomfort’ and pressure on exertion with difficulty in taking a deep breath and intermittent shortness of breath. Labs revealed biomarker elevation. The patient was diagnosed with non-fatal myocardial infarction and subsequently underwent catheterization and percutaneous coronary intervention with a drug-eluting stent to the mid-LAD during this hospitalization (B—note the yellow lines demarcating the maxLCBI_4 mm). (C) The chemogram of the ‘Ware’ segment (showing the maxLCBI_4 mm demarcated by the two orange lines corresponding to the broken orange lines on the angiogram) shows a diffuse segment of lipid-rich plaque on the near-infrared spectroscopy chemogram map at index. (D) The corresponding intravascular ultrasound cross-sections with the chemogram rings. Note the presence of calcium in two quadrants.