Abstract 905: Chronic Kidney Disease as a Predictor of Greater Coronary Plaque Burdens
Background: Chronic kidney disease (CKD) has been associated with adverse cardiovascular risk and mortality where coronary plaque instability significantly affects on the occurrence of acute coronary syndrome. Few studies have examined the relevance of CKD with coronary plaque, especially with its tissue components. This study sought to determine lipid and fibrous volume of coronary atherosclerotic plaques in subjects with CKD by integrated backscatter intravascular ultrasound (IB-IVUS).
Methods: Conventional and IB-IVUS using 40-MHz (motorized pullback 0.5mm/s) intravascular catheter was performed to 206 consecutive patients with 289 obstructive coronary lesions. Three-dimensional analyses of conventional and IB-IVUS were performed to determine the total plaque volume (tPV), the percentage of lipid volume (% LV) and fibrous volume (% FV). We defined the cut-off point for plaque rich lesions as tPV>248 mm3, which was the 90th percentile of tPV in this study population. Glomerular filtration rate was estimated (eGFR) using the simplified Modification of Diet in Renal Disease Study equation. CKD was then defined as eGFR <60 ml/min/1.73 m2, and was divided into three groups according to eGFR (stage 3a CKD, stage 3b CKD and stage 4–5 CKD, defined as GFR of 45 to 59, 30 to 44 and GFR of less than 30 ml/min/1.73 m2, respectively).
Results: On linear regression analysis, eGFR was significantly correlated with tPV (r=−0.21, p=0.0003), while there was no significant correlation between eGFR and plaque contents (% LV and % FV). Stage 3b CKD (r=0.15, p=0.01) and stage 4 CKD (r=0.18, p=0.003) were significantly correlated with tPV. After adjusting for confounding and coronary risk factors, the prevalence of stage 4 CKD (odds ratio=5.24, 95% confidence interval, 1.52 to 18.1, p=0.009) and diabetes mellitus (odds ratio=2.74, 95% confidence interval, 1.03 to 7.27, p=0.04) were independently associated with greater plaque volume.
Conclusions: Moderate to severe CKD is associated with plaque rich coronary lesions. Impact of CKD on coronary plaque characteristics is mainly due to the increased plaque volume rather than lipid-rich plaque contents.