Abstract 3116: Subclinical Coronary Atherosclerosis Detected by Coronary CT Angiography in Asymptomatic Population with and without Mild Renal Insufficiency
BACKGROUND The prevalence of coronary artery disease (CAD) increased in patients with moderate to severe renal insufficiency. The impact of renal insufficiency on the development of CAD may increase as renal function continues to deteriorate, however, there is no data available in mild renal insufficiency. The purpose of this study was to explore the association between mild renal insufficiency and coronary atherosclerosis, using coronary CT angiography (CCTA).
METHODS We consecutively enrolled 4984 asymptomatic subjects (mean age 49 ± 10 years, 61% male), who underwent CCTA (64-slice MDCT) as part of a general health evaluation. We categorized subjects based on their estimate of renal function (estimated glomerular filtration rate (eGFR), using MDRD equation: ≥ 60 vs. 45 to 59 ml/min/1.73 m2). Patients with eGFR less than 45 ml/min/1.73 m2 were excluded. Coronary artery calcium score (CACS), presence of plaque, and significant stenosis (≥ 50% lumen diameter) were compared between 2 groups. Regression analysis was performed to assess the correlation between CAD and mild renal insufficiency.
RESULTS Three hundreds forty-two subjects (7%) had mild renal insufficiency (eGFR: 45 to 59) and 4642 (93%) had normal renal function (eGFR: ≥ 60 ml/min/1.73 m2). Subjects with mild renal insufficiency showed higher incidence of CAD (124 (36%) vs. 1039 (22%), p<0.001) and significant stenosis (31 (9%) vs. 147 (3%), p<0.001). However, after adjusting conventional risk factors, mild renal insufficiency was no longer an independent risk factor for the presence of CAD and significant stenosis. Furthermore, after age and sex-matching, there was no significant difference in incidence of moderate to severe (≥ 100) CACS (44 (13%) vs. 39 (12%), p=0.64), CAD (122 (36%) vs. 114 (34%), p = 0.57), and significant stenosis (11 (9%) vs. 9 (6%), p = 0.19) between 2 groups.
CONCLUSIONS The higher incidence of CAD and significant stenosis in subjects with mild renal insufficiency was observed, however, which are primarily attributed to the effect of other conventional risk factors. Mild renal insufficiency may not act as an independent risk factor for coronary atherosclerosis.