Characteristics of conventional high-risk coronary plaques and a novel CT defined thin-cap fibroatheroma in patients undergoing CCTA with stable chest pain

•We define a novel high-risk coronary plaque, the CT-TCFA based on the CT-defined ratio of necrotic core to fibrous plaque.•CT-TCFA significantly overlap with current CT-defined high-risk coronary plaque with a predilection to proximal coronaries.•The inter-observer variability of CT-TCFAs is lower than conventional CT-defined high-risk coronary plaques.•The presence of CT-TCFA is associated with increased MACE over long term follow up.