Objective To investigate the relationship between staging of retinal artery lesions and the prognosis of acute coronary syndrome (ACS) in a Chinese population. Methods A total of 436 Chinese patients with ACS underwent coronary angiography and the eyes fundus examinations. All the patients were divided into three groups: group 1, no retinal artery lesions (n = 111); group 2, retinal artery lesions of <Stage 2 (Stage 1-a broadening of the light reflex from the artery can be seen, with minimal or no arteriovenous compression; n = 135); and group 3, retinal artery lesions of >= Stage 2 (Stage 2-the changes similar to those in Stage 1, but more prominent, Stage 3-the arteries have a 'opper wire' appearance and this is much more arteriovenous compression, and Stage 4-the arteries have a 'ilver wire' appearance and the arteriovenous crossing changes are more severe; n = 190). The endpoints were main adverse cardiovascular and cerebrovascular events (MACCE), including all-cause death, myocardial infarction (MI), and stroke after 3-6 years of follow-up. Results There was no significant differences of the baseline data among the three groups. After 3-6 years of follow-up, we found that patients of group 3 had more MACCE and death than those of the group 1 or group 2. Cox regression analysis found that factors related to the prognosis of ACS was staging of retinal artery lesions (P<.05) in addition to traditional risk factors such as age, gender, diabetes, hypertension, and hypercholesterolemia. Conclusion Staging of retinal artery lesions plays an important role in the long-term outcome of patients with ACS.