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Coronary low-attenuation plaque and high-sensitivity cardiac troponin
Mohammed N Meah1, Ryan Wereski2, Anda Bularga2
1British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK m.meah1@nhs.net.
Insights
Elevated cardiac troponin I levels (≥5 ng/L) in acute chest pain patients without myocardial infarction indicate a higher burden of dangerous low-attenuation coronary plaque. This finding highlights troponin
Area of Science:
- Cardiology
- Biomarkers
- Medical Imaging
Background:
- Elevated plasma cardiac troponin I concentrations (≥5 ng/L) in patients presenting with acute chest pain, after excluding myocardial infarction, are linked to future adverse cardiovascular events.
- Understanding the underlying coronary plaque characteristics associated with these elevated troponin levels is crucial for risk stratification.
Purpose of the Study:
- To evaluate the association between cardiac troponin I concentrations and the composition of coronary plaque in patients with acute chest pain but without myocardial infarction.
- To determine if elevated troponin levels correlate with specific types of coronary plaque, particularly non-calcified or low-attenuation plaque.
Main Methods:
- A secondary analysis of a prospective cohort study involving 242 patients with acute chest pain and excluded myocardial infarction.
- Quantitative plaque analysis was performed on CT coronary angiograms, stratifying patients by peak plasma cardiac troponin I concentration (≥5 ng/L vs. <5 ng/L).
- Univariable and multivariable logistic regression analyses were used to assess associations between troponin levels and plaque characteristics.
Main Results:
- Patients with troponin I ≥5 ng/L (n=161) exhibited a significantly higher burden of total, non-calcified, calcified, and low-attenuation coronary plaque compared to those with levels <5 ng/L (n=81).
- Specifically, low-attenuation plaque burden was independently associated with troponin I concentrations ≥5 ng/L, even after adjusting for clinical factors or the presence of coronary artery disease.
- The adjusted odds ratio for low-attenuation plaque burden per doubling of troponin I was 1.62 (95% CI 1.17 to 2.32, p=0.005) or 1.57 (95% CI 1.07 to 2.37, p=0.026).
Conclusions:
- In patients with acute chest pain and no myocardial infarction, elevated plasma cardiac troponin I concentrations (≥5 ng/L) are associated with a greater burden of low-attenuation coronary plaque.
- This suggests that elevated troponin levels in this context may reflect underlying plaque vulnerability or instability.
- Further research may explore the prognostic implications of low-attenuation plaque in conjunction with elevated troponin in this patient population.
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.
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