Elevated high-sensitivity c-reactive protein correlates with coronary plaque burden and composition: differential associations in post-myocardial infarction versus stable coronary artery disease

Abstract Background Inflammation is pivotal in atherosclerosis, and high-sensitivity C-reactive protein (hs-CRP) is a recognized biomarker of systemic inflammation. However, its association with coronary plaque burden and composition may differ between stable coronary artery disease (CAD) and post-acute myocardial infarction (AMI) patients, with potential implications for risk stratification and management. Purpose This study aimed to investigate the association between hs-CRP and coronary plaque burden, specifically total plaque volume (PV), non-calcified PV, and necrotic core/fibro-fatty PV, using coronary computed tomography angiography (CCTA), and to determine whether these relationships vary between stable CAD and post-AMI patients. Methods A total of 141 patients with stable CAD and 205 post-AMI patients (within two months) with available hs-CRP measurements who underwent CCTA were retrospectively analyzed. Lumen and vessel wall segmentation was performed, followed by quantification of total and compositional PV. Plaque composition was classified as necrotic core, fibro-fatty, fibrous, or calcified based on Hounsfield unit (HU) thresholds: -30 to 30, 31 to 130, 131 to 350, and 350, respectively. Multivariable linear regression models were constructed, adjusting for age, gender, diabetes mellitus, hyperlipidemia, hypertension, smoking status, ethnicity, and aspirin and statins use. In the combined cohort (stable CAD + post-AMI), models were further adjusted for AMI status. Results In the combined cohort, hs-CRP demonstrated significant positive associations with total PV (β = 0.003, P = 0.004), non-calcified PV (β = 0.004, P = 0.002), and necrotic core/fibro-fatty PV (β = 0.005, P = 0.026). Among post-AMI patients, hs-CRP remained significantly associated with total PV (β = 0.003, P = 0.007) and non-calcified PV (β = 0.004, P = 0.006), with a borderline association for necrotic core/fibro-fatty volume (β = 0.005, P = 0.072). In the stable CAD group, no significant associations were observed (Table 1). Conclusion Our findings demonstrate that hs-CRP is significantly associated with coronary plaque burden and composition, particularly non-calcified and necrotic core/fibro-fatty plaques, with a stronger association in post-AMI patients. These results highlight the importance of aggressive inflammatory risk management in the post-AMI setting to mitigate adverse plaque progression.Table 1