Acute coronary syndrome (ACS) is one of the most serious cardiovascular diseases endangering human health. For a long time, plaque rupture (PR), the release of plaque contents accompanying and the formation of mural thrombus are considered as the major mechanism for the formation of ACS. With the application of optical coherence tomography (OCT), it is realized that, in addition to PR, plaque erosion (PE) is another important and common pathological mechanism of ACS. In recent years, the research on PE has made good progress. This paper will summarize the research progress on the diagnosis and treatment of PE.