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Coronary Plaque Characteristics in Hemodialysis-Dependent Patients as Assessed by Optical Coherence Tomography
Chee Yang Chin1, Mitsuaki Matsumura2, Akiko Maehara3
1Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York; Department of Cardiology, National Heart Centre Singapore, Singapore.
Insights
Patients on hemodialysis (HD) show more coronary calcium, including a unique form of thin intimal calcium, compared to those without chronic kidney disease (CKD). This finding may impact how calcium burden is assessed in HD patients.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Medical Imaging
Background:
- Chronic kidney disease (CKD) is linked to advanced atherosclerosis and calcification in coronary arteries.
- Hemodialysis (HD)-dependent patients often present with complex cardiovascular issues.
Purpose of the Study:
- To characterize coronary plaque, specifically calcium distribution, in HD-dependent patients using optical coherence tomography (OCT).
- To compare coronary plaque characteristics between HD-dependent patients and a matched cohort without CKD.
Main Methods:
- A multicenter, retrospective study involving 124 patients with stable angina.
- Optical coherence tomography (OCT) imaging was used to assess coronary lesions.
- Sixty-two HD-dependent patients were matched 1:1 with patients without CKD based on age, diabetes, gender, and culprit vessel.
Main Results:
- HD-dependent patients exhibited significantly greater mean calcium arcs in both culprit and non-culprit lesions.
- A higher prevalence of thin intimal calcium (>30° arc within <0.5 mm intima) was observed in the HD group (41.9% vs 4.8%).
- Calcified nodules were more frequent in HD patients, but no differences in lipid arcs or thin-cap fibroatheroma were found.
Conclusions:
- HD-dependent patients have more widespread coronary calcium, including a distinct pattern of thin intimal calcium, not seen in non-CKD individuals.
- This thin intimal calcium may lead to overestimation of calcium burden by intravascular ultrasound.
- The unique calcification patterns in CKD patients might explain discrepancies between coronary artery calcification scores and long-term outcomes.
Abstract:
Coronary arteries in patients with chronic kidney disease (CKD) have been shown to exhibit more extensive atherosclerosis and calcium. We aimed to assess characteristics of coronary plaque in hemodialysis (HD)-dependent patients using optical coherence tomography (OCT). This was a multicenter, retrospective study of 124 patients with stable angina who underwent OCT imaging. Sixty-two HD-dependent patients who underwent pre-intervention OCT for coronary artery disease were compared 1:1 with a cohort of patients without CKD, matched for age, diabetes mellitus, gender, and culprit vessel. Baseline characteristics were comparable. Pre-intervention OCT imaging identified 62 paired culprit, 53 paired non-culprit, and 19 paired distal vessel lesions. Lesion length, minimum lumen area, and area stenosis were similar between groups. The HD-dependent group had greater mean calcium arcs in culprit (54.3° vs 26.4°, p = 0.004) and non-culprit lesions (34.3° vs 24.5°, p = 0.02) and greater maximum calcium arc in distal vessel segments (101.6° vs 0°, p = 0.03). There were no differences in lipid arcs between groups. There was a higher prevalence of thin intimal calcium, defined as an arc of calcium >30° within intima <0.5 mm thick, in patients in the HD-dependent group (41.9% vs 4.8%, p <0.001). There was a higher prevalence of calcified nodules in the HD-dependent group (24.2% vs 9.7%, p = 0.049) but no differences in medial calcification or thin-cap fibroatheroma. In conclusion, in this OCT study, HD-dependent patients, compared with matched patients without CKD, had more extensively distributed coronary calcium and uniquely, a higher prevalence of non-atherosclerotic thin intimal calcium. This thin intimal calcium may cause an overestimation of calcium burden by intravascular ultrasound and may contribute to the lack of correlation between increased coronary artery calcification scores with long-term outcomes in patients with CKD.
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