Recent research points to unstable, rather than stenotic plaque, as a major cause of heart attacks. Cardiologists, as much as entrepreneurs and large companies, are therefore driving the creation of new cardiac detection platforms based on characterizing arterial plaque in order to identify patients that are unaware that they are at risk of suffering a myocardial infarction. First-generation detection tools are well along in development, but the scientific understanding about plaque is evolving so rapidly, technologies may be obsolete by the time they are ready for commercialization. Finally, looking for heart attack risk in symptomless patients means screening apparently healthy patients based on risk factors. Clinicians aren't yet prepared for the treatment implications and payers aren't ready for the economic burden of widespread screening, and this presents one of the greatest challenges for companies introducing new plaque detection technologies.