Background: Conventional intravascular ultrasound (IVUS) is widely used to evaluate coronary plaque characteristics but it provides a limited definition of vulnerable plaque. Recently new intravascular modalities including virtual histology (VH) and optical coherence tomography (OCT) were developed and studied to assess vulnerable plaque in clinical setting. Methods: To compare three kinds of intravascular modalities for detection vulnerable plaque, patients undergoing cardiac catheterization were enrolled and categorized according to their clinical presentation into stable angina pectoris (SAP) and acute coronary syndrome (ACS) and IVUS, VH and OCT imaging were performed sequencially. Two observers independently analyzed the images using the previously validated criteria for plaque characterization. Results: Of 37 patients enrolled, 37 patients (20 with ACS and 17 with SAP) had analyzable images. The presence of lipid core in IVUS is related to clinical presentation (p=0.039). In OCT analysis, lipid-rich plaque (defined by lipid occupying 2 quadrants of the cross-sectional area) (p=0.019), thickness of fibrous cap (p=0.016) and the presence of thrombus in OCT (p=0.001) were significantly correlated with clinical presentation. Although the frequency of thin-cap fibroatheroma in VH imaging has a higher tendency in ACS (p=0.087), none of parameters in VH is correlated with clinical presentation. Conclusions: This is the study to compare currently available intravascular modalities for detailed in vivo plaque morphology in patients with different clinical presentations. OCT for vulnerable plaque is feasible and provides superior contrast and resolution of arterial pathology than other modalities.