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Coronary plaque characteristics in patients with mild chronic kidney disease. Analysis by 320-row area detector
Hideki Kawai1, Masayoshi Sarai, Sadako Motoyama
1Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.
Insights
Patients with mild chronic kidney disease (CKD) have more severe coronary artery stenosis. High-risk plaque prevalence did not differ, suggesting stenosis severity, not plaque type, drives coronary event risk in mild CKD.
Area of Science:
- Cardiology
- Nephrology
- Radiology
Background:
- Mild chronic kidney disease (CKD) impacts coronary plaque characteristics, previously unstudied with 320-row area detector CT.
- CKD affects cardiovascular health, necessitating investigation into coronary artery disease (CAD) in mild CKD populations.
Purpose of the Study:
- To compare coronary plaque characteristics between patients with mild CKD (eGFR 30-59 ml·min(-1) · 1.73 m(-2)) and those without CKD (eGFR ≥60) using 320-row area detector CT.
- To investigate the relationship between CKD, coronary stenosis severity, and high-risk plaque features.
Main Methods:
- 487 patients with suspected stable CAD underwent coronary CT angiography.
- Coronary plaques were analyzed for vessel remodeling, consistency, calcification, and high-risk features (positive remodeling/low-attenuation).
- Comparison of diseased segments, stenosis severity, and high-risk plaque prevalence between mild CKD and no CKD groups.
Main Results:
- Mild CKD patients had more diseased segments per patient (4.61±3.83 vs. 2.95±3.11, P<0.0001).
- Severe stenosis (≥70% luminal diameter) was significantly higher in mild CKD (35.1% vs. 19.4%, P=0.0003).
- No significant difference in high-risk plaque prevalence was observed (13.0% vs. 9.8%, P=0.3189).
Conclusions:
- Coronary artery stenosis severity is increased in patients with mild CKD.
- High-risk plaque characteristics did not significantly differ between groups.
- The elevated coronary event risk in mild CKD may be attributed to stenosis severity rather than plaque composition.
Background:
The differences in the coronary plaque characteristics between patients with mild chronic kidney disease (CKD) (estimated glomerular filtration rate [eGFR] 30-59 ml·min(-1) · 1.73 m(-2)) and those without CKD (eGFR ≥60) by 320-row area detector computed tomography (CT) have not been studied.
Methods And Results:
We enrolled 487 patients undergoing coronary CT angiography with suspected stable coronary artery disease (mean age: 66.6±10.8 years, 131 with mild CKD) and analyzed 6,352 segments. All coronary plaques were characterized for the presence of vessel remodeling, plaque consistency and the disposition of coronary calcification, and a plaque with positive vessel remodeling and/or low-attenuation was defined as high risk. The number of diseased segments per patient was higher in mild CKD patients than in those without CKD (4.61±3.83 vs. 2.95±3.11, P<0.0001). The prevalence of severe stenosis (≥70% luminal diameter) was significantly higher in cases of mild CKD than in no CKD (35.1% vs. 19.4%, P=0.0003), but there was no significant difference in the prevalence of high-risk plaque (13.0% vs. 9.8%, P=0.3189).
Conclusions:
The severity of coronary artery stenosis was higher in the patients with mild CKD, though there was no significant difference in the prevalence of high-risk plaque. We suggest that the high risk of coronary events in patients with CKD is related to the severity of stenosis rather than to the characteristics of plaque.
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