Dynamic natural components and morphological changes in nonculprit subclinical atherosclerosis in patients with acute...

Area of Science:

• Cardiovascular Medicine
• Nephrology
• Medical Imaging

Background:

• Coronary plaque progression in acute coronary syndrome (ACS) patients with chronic kidney disease (CKD) presents unique characteristics.
• Optical coherence tomography (OCT) and optical flow ratio (OFR) software enable quantitative analysis of coronary plaque.
• Nonculprit subclinical atherosclerosis (NSA) is a significant factor in ACS outcomes.

Purpose of the Study:

• To compare the progression of NSA in ACS patients with and without mild CKD.
• To investigate the morphological changes in NSA, particularly calcification, in relation to CKD status.
• To assess the long-term incidence of NSA-related major adverse cardiovascular events (MACE) in these patient groups.

Main Methods:

• A cohort of 184 ACS patients with baseline and 1-year OCT follow-up were divided into non-CKD (eGFR > 90) and mild CKD (60 ≤ eGFR < 90) groups.
• Normalized total atheroma volume (TAVn) changes in NSA served as the primary endpoint.
• Morphological changes, including calcification and distance from calcified surface to coronary media (ΔC-to-M), were analyzed.

Main Results:

• Mild CKD patients exhibited significantly greater TAVn progression of NSA compared to non-CKD patients (p = 0.019).
• This progression was primarily driven by an increase in calcified plaque volume (p < 0.001) and altered plaque morphology.
• Mild CKD patients had a higher incidence of NSA-related MACE at 5-year follow-up (30.8% vs. 5.8%, p = 0.045).

Conclusions:

• Mild CKD is associated with accelerated NSA progression, characterized by increased calcification and lumen protrusion.
• These morphological changes in NSA correlate with a higher risk of future cardiovascular events in ACS patients with mild CKD.
• Quantitative OCT analysis provides valuable insights into the unique plaque behavior in ACS patients with CKD.