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Objective: We evaluated the relationship of coronary plaque characteristics including the plaque color with the long-term clinical outcomes in patients with acute coronary syndrome (ACS). Methods: Consecutive 339 ACS patients treated with percutaneous coronary intervention (PCI) were enrolled in the present study. The culprit lesions were examined by coronary angioscopy and were divided into three groups: thick yellow plaque: TYP, yellow plaque: YP, white plaque: WP. Major adverse cardiac event (MACE) was defined as the composite of cardiovascular death, nonfatal acute myocardial infarction (AMI), unstable angina (UAP), heart failure admission, and the need for PCI or coronary artery bypass grafting. Results: TYP and ruptured plaque were observed in AMI more frequently than in UAP. Among the three groups of plaque color, baseline clinical characteristics was similar except lower body mass index and LDL-cholesterol level in WP group. In contrast to YP group, TYP group showed more ruptured plaques, and WP group showed less ruptured or eroded plaques. During the median follow-up of 3.5 years, the incidence of MACE was reduced in TYP group and similar between WP and YP groups by Kaplan-Meier analysis. An increased incidence of UAP and a trend of increased target vessel revascularization were observed in WP group. Conclusions: In ACS patients with PCI, the TYP in culprit lesions was independently associated with the long-term favorable prognosis and the WP independently predicted with high incidence of UAP. These relationships might provide new insights for prevention of the secondary cardiac events after ACS.
