Objective: We aimed to explore the utility of atherogenic index of plasma (AIP) on plaque burden detected by coronary computed tomography angiography (CCTA) in patients with chest pain and intermediate probability of coronary artery disease (CAD). Methods: AIP was calculated as the logarithmically transformed ratio of the serum triglycerides to HDL- cholesterol in 167 patients with chest pain (age 46.5 ± 11.8 yrs; 104 were men) and correlated with segment stenosis score (SSS), SIS and total plaque score (TPS), studied with CCTA, and compared with other lipid ratios. Results: Obstructive CAD lesions were detected in 45.5% of patients with intermediate pretest probability of CAD. CCTA documented CAD was detected in 61.7% subjects with AIP value >0.24, while CAD was detected in 26.5% patients with AIP value <0.24. AIP was 0.49 ± 0.12 in patients with CAD versus 0.14 ± 0.03; p<0.001 in those without CAD. The total coronary artery calcium score (CACS) was significantly higher in patients with AIP >0.24 than in patients with AIP <0.24 (p<0.001). AIP was correlated with SSS, SIS, TPS, and CACS (p<0.001). Moreover, it seems to be the strongest ratio than other lipid ratios. AIP was the strongest predictor of plaque burden. ROC analysis demonstrated that AIP >0.29 was the optimal cut-off value in predicting CAD, with AUC=0.78, p<0.001, and it was the strongest discriminator index compared with other lipid indices. Conclusion: AIP was significantly correlated with plaque burden and extent of CAD in patients with intermediate pretest probability of CAD who presented with chest pain and it could help in risk stratification.