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The success in cardiovascular prevention has reduced the incidence of acute coronary syndromes (ACS: unstable angina or myocardial infarction with or without ST-segment elevation) in the majority of developed countries and has delayed the age when these present . Although percutaneous coronary intervention (PCI) and pharmacologic therapies have improved the prognosis for such patients, recurrent major adverse cardiovascular events occur in a substantial proportion of cases . That implies the importance of understanding the underlying pathophysiology and risk factors that lead to secondary cardiac events . Coronary angioscopy (CAS) allows direct visualization of the intravascular lumen and provides information that cannot be obtained by angiography on plaque shape and color and on the presence and the size of thrombi . To date, several studies including ours have described the angioscopic characteristics of the infarct-related lesions early after acute myocardial infarction (AMI). The different types of vulnerable plaques such as ruptured and eroded plaque have been recognized and the high prevalence of thrombus has been detected . In addition, we have recently reported that the thick yellow plaque (TYP) in culprit lesions was independently associated with the long-term favorable prognosis after AMI in patients treated with PCI . Although, in ACS, it has been reported that the plaque color by CAS may be related with the fibrous cap thickness and plaque vulnerability , few data are available on the relationship between angioscopic findings and the clinical characteristics/outcomes in such patients. Therefore, we assessed the relationship of angioscopic evaluation performed immediately before PCI with clinical findings including the long-term outcomes in a cohort of 339 patients with ACS. In particular, we analyzed the CAS findings focusing on the TYP and the white color plaque, and evaluated whether CAS findings yield prognostic information above that of traditional multivariable risk models. Original Paper

Plaque Color by Angioscopic Evaluation was Associated on Long-term Clinical Outcomes in Patients with Acute Coronary Syndrome