Clinical Characteristics and Outcomes of Patients Presenting with Acute Coronary Syndromes and Suspected Plaque Erosion Based on Clinical and Laboratory Criteria

<b>Background:</b> Plaque erosion (PE) ranks as the second most prevalent pathology associated with acute coronary events, following plaque rupture. PE is characterized by endothelial denudation and the development of neutrophil extracellular traps. Specific clinical and laboratory predictors were shown to be associated with PE in patients with acute coronary syndrome. The aim of this study was to evaluate the clinical and laboratory results, as well as the outcomes of ACS patients with a high likelihood of PE. <b>Methods:</b> A total of 696 ACS patients were categorized into the suspected PE group and the less likely PE group based on the five validated predictors of PE. Baseline clinical characteristics and laboratory evaluations were analyzed between the two groups. Major adverse cardiovascular events were compared between the two groups at 20 months. <b>Results:</b> The group suspected of PE comprised 41% of patients, whereas the group with a lower likelihood of PE constituted 59%. The suspected PE group exhibited a greater incidence of current smokers and a higher BMI. Both CRP and fibrinogen levels were decreased; the incidence of one coronary vessel disease was elevated. The suspected PE group exhibited a markedly reduced incidence of MACEs at 20 months (7.4% compared to 28.8%, <i>p</i> = 0.0001). The recurrence of non-fatal coronary events tended to occur later in the suspected PE group (15 months (6-20) compared to 9 months (6-13), <i>p</i> = 0.062). A reduced coronary plaque burden and a low level of systemic inflammation characterized the distinctive features of the suspected PE cohort. <b>Conclusions:</b> The suspected PE group exhibited a more favorable prognosis at the 20-month follow-up, characterized by a considerably reduced mortality rate from all causes, whereas non-fatal coronary events tended to manifest at a later time.