Backgrounds: It has not been reported that the impact of plaque composition on long-term clinical outcomes in patients underwent percutaneous coronary intervention (PCI), although plaque composition has many clinical significance such as positive remodeling, slow flow, etc. Methods: The study subjects consisted of 337 consecutive patients (mean 58.7짹11.9 years old, 245 males) who underwent PCI and Virtual Histology-intravascular ultrasound (VH-IVUS) examination. Major adverse cardiovascular events (MACE) including death, myocardial infarction, stroke, revascularization and restenosis were evaluated according to binary patient group that divided by tissue characteristics during mean 28 months` follow up period. Results: Patients with high fibrofatty volume (FFV> 8.90mm³, n=166, mean 62.4 years old) had higher incidence of ACS (54.1% vs. 35.7%, p=0.001), lower ejection fraction (60.9% vs. 64.6%, p=0.002), peak CK-MB level (68.9 ng/ml vs. 39.8 ng/ml, p=0.006), longer stent length (24.35 mm vs. 21.36 mm, p=0.000), larger lesion length(21.37 mm vs. 16.26 mm, p<0.001), larger lumen volume (141.3mm3 vs. 87.1mm3, p<0.001), larger EEL volume (381.0 mm3 vs 197.3 mm3 , p<0.001) than those with low FFV (8.90mm³, n=170, mean 60.9 years old). Patients with high FFV had significantly higher incidence (28.1% [n=47] vs. 17.6%, p=0.022 [n=30]) of MACE than those with low FFV. Cox regression analysis revealed that the FFV had negative impact (HR 1.980, 95% confidence interval [CI] 1.058 to 3.704, p=0.033) on MACE, whereas dense calcified volume had protective effect (HR 0.200, 95% CI 0.080 to 0.498, p=0.001). When we divided the study population according to the fibrous volume, dense calcium volume, necrotic core volume, there was no significant finding in terms of demographics and MACE. Conclusions: FFV has negative impact on long-term clinical outcomes, whereas dense calcified volume has positive impact in patients underwent PCI during more than 2 years follow up period.