RT Journal Article SR Electronic T1 Coronary low-attenuation plaque and high-sensitivity cardiac troponin JF Heart JO Heart FD BMJ Publishing Group Ltd and British Cardiovascular Society SP heartjnl-2022-321867 DO 10.1136/heartjnl-2022-321867 A1 Mohammed N Meah A1 Ryan Wereski A1 Anda Bularga A1 Edwin J R van Beek A1 Marc R Dweck A1 Nicholas L Mills A1 David E Newby A1 Damini Dey A1 Michelle Claire Williams A1 Kuan Ken Lee YR 2023 UL http://heart.bmj.com/content/early/2023/01/11/heartjnl-2022-321867.abstract AB Objective In patients with acute chest pain who have had myocardial infarction excluded, plasma cardiac troponin I concentrations ≥5 ng/L are associated with risk of future adverse cardiovascular events. We aim to evaluate the association between cardiac troponin and coronary plaque composition in such patients.Methods In a prespecified secondary analysis of a prospective cohort study, blinded quantitative plaque analysis was performed on 242 CT coronary angiograms of patients with acute chest pain in whom myocardial infarction was excluded. Patients were stratified by peak plasma cardiac troponin I concentration ≥5 ng/L or <5 ng/L. Associations were assessed using univariable and multivariable logistic regression analyses.Results The cohort was predominantly middle-aged (62±12 years) men (69%). Patients with plasma cardiac troponin I concentration ≥5 ng/L (n=161) had a higher total (median 33% (IQR 0–47) vs 0% (IQR 0–33)), non-calcified (27% (IQR 0–37) vs 0% (IQR 0–28)), calcified (2% (IQR 0–8) vs 0% (IQR 0–3)) and low-attenuation (1% (IQR 0–3) vs 0% (IQR 0–1)) coronary plaque burden compared with those with concentrations <5 ng/L (n=81; p≤0.001 for all). Low-attenuation plaque burden was independently associated with plasma cardiac troponin I concentration ≥5 ng/L after adjustment for clinical characteristics (adjusted OR per doubling 1.62 (95% CI 1.17 to 2.32), p=0.005) or presence of any visible coronary artery disease (adjusted OR per doubling 1.57 (95% CI 1.07 to 2.37), p=0.026).Conclusion In patients with acute chest pain but without myocardial infarction, plasma cardiac troponin I concentrations ≥5 ng/L are associated with greater burden of low-attenuation coronary plaque.Data are available upon reasonable request.