Abstract
The classical concept of plaque vulnerability, centred on specific morphological features, has failed to deliver reliable risk prediction in clinical practice. Recent evidence highlights the need to redefine coronary vulnerability as a dynamic, patient-specific phenotype shaped by plaque biology, systemic inflammation, and haemodynamic forces. Advanced imaging modalities, artificial intelligence, and circulating biomarkers now enable a multidimensional assessment of this complex phenotype. This integrative approach may offer a more precise framework for risk stratification and personalised prevention in coronary artery disease.