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Updated: Jun 11, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Coronary Plaque Characteristics in Patients With Chronic Kidney Failure: Impact on Cardiovascular Events and
Jonathan Nørtoft Dahl1,2, Marie B Nielsen3,4, Laust D Rasmussen1,5
1Department of Cardiology, Gødstrup Hospital, Herning, Denmark (J.N.D., L.D.R., M.B., S.W.).
Insights
In chronic kidney failure patients, calcified and low-attenuation plaque burdens predict major adverse cardiovascular events (MACE) and mortality. High-risk plaques and coronary artery calcium score are linked to MACE but not mortality.
Area of Science:
- Cardiology
- Nephrology
- Radiology
Background:
- Coronary artery disease (CAD) features like high-risk plaques and low-attenuation plaque burden are linked to major adverse cardiovascular events (MACE).
- Chronic kidney failure (CKF) patients may exhibit distinct CAD characteristics.
- This study investigated CAD plaque features and extent in CKF patients concerning MACE and all-cause mortality.
Purpose of the Study:
- To assess the association between coronary plaque characteristics and CAD extent with MACE and all-cause mortality in CKF patients.
- To determine if specific plaque features predict adverse cardiovascular outcomes in this population.
- To evaluate the role of coronary computed tomography angiography (CCTA) in risk stratification for CKF patients.
Main Methods:
- Included potential kidney transplant candidates undergoing CCTA screening.
- Evaluated high-risk plaques and diameter stenosis semiqualitatively.
- Quantified coronary artery calcium score and plaque burden (atheroma volume).
Main Results:
- In 484 CKF patients, 56 experienced MACE and 69 died over 4.9 years.
- High-risk plaques were present in 70% of MACE patients.
- Quantified calcified and low-attenuation plaque burdens independently predicted MACE and all-cause mortality (HRs 1.6-2.6).
Conclusions:
- Calcified and low-attenuation plaque burdens are independent predictors of MACE and all-cause mortality in CKF patients.
- High-risk plaques and coronary artery calcium score are associated with MACE but not all-cause mortality.
- CCTA-derived plaque quantification offers valuable risk stratification for CKF patients.
Background:
In patients with coronary artery disease, coronary plaques with high-risk features and low-attenuation plaque burden are independent measures associated with major adverse cardiovascular events (MACEs). Patients with chronic kidney failure may have different coronary artery disease characteristics. The aim was to assess the association of coronary plaque characteristics and coronary artery disease extent with MACE and all-cause mortality in patients with chronic kidney failure.
Methods:
Potential kidney transplant candidates who underwent coronary computed tomography angiography as part of the cardiac screening program before kidney transplantation were included. We evaluated high-risk plaques and diameter stenosis semiqualitatively and quantified coronary artery calcium score and plaque burden (percentage atheroma volume).
Results:
In 484 patients with chronic kidney failure and few or no symptoms of coronary artery disease (mean age, 53±12 years; 62% men; 32% on dialysis), 56 (12%) patients suffered MACE and 69 (14%) patients died during a median follow-up of 4.9 years. High-risk plaques were present in 39 (70%) patients with MACE. Median calcified plaque burden was 3.7% in patients with MACE versus 0.2% in patients without MACE. The median low-attenuation plaque burden was 0.3% versus 0.03%, respectively. In semiqualitative analyses, the presence of high-risk plaque and a higher coronary artery calcium score were associated with increased risk of MACE (hazard ratio (HR), 2.0 [95% CI, 1.0-3.7]; P=0.040; HR, 1.2 [95% CI, 1.0-1.3]; P=0.014), respectively. Neither were associated with all-cause mortality. In quantified analysis, increasing levels of both calcified and low-attenuation plaque burdens were associated with risk of MACE (HR, 2.6 [95% CI, 1.8-3.7]; P<0.001; HR, 2.6 [95% CI, 1.5-4.5]; P=0.001 [per variable doubling, respectively]) and all-cause mortality (HR, 1.6 [95% CI, 1.2-2.1]; P=0.002; HR, 1.8 [95% CI, 1.1-3.0]; P=0.028, respectively).
Conclusions:
In patients with chronic kidney failure, calcified and low-attenuation plaque burdens were independently associated with MACE and all-cause mortality, while high-risk plaques and coronary artery calcium score were only associated with MACE.
Registration:
URL: https://www.clinicaltrials.gov; Unique identifier: NCT01344434.
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