Abstract 18256: Impact of Chronic Kidney Disease Staging on Coronary Atherosclerotic Plaque Change of Non-culprit Lesions after Culprit Percutaneous Coronary Intervention
Introduction: Renal dysfunction is associated with increased coronary plaque burden, which may cause future coronary events. However, little is known about the impact of chronic kidney disease (CKD) staging on coronary atherosclerotic plaque change of non-culprit lesions (NCL) under standard medical therapy after culprit percutaneous coronary intervention (PCI). We investigated serial coronary plaque change of NCL in patients with different stages of CKD using integrated backscatter intravascular ultrasound (IB-IVUS).
Methods: We investigated 113 NCL in 113 patients undergoing both IVUS-guided PCI and follow-up IVUS examination. Patients were divided into 4 groups according to baseline CKD stage: CKD-1, n=18; CKD-2, n=43; CKD-3, n=29; and CKD 4-5, n=24. Volumetric IVUS analyses were performed at proximal NCL in de novo target vessels post PCI and at 8-month follow-up. We compared serial changes of plaque burden and composition among groups under standard medical therapy including statins.
Results: Baseline patient characteristics showed age was significantly older, diabetic patients were more in CKD-3 than the other groups, but otherwise there was no significant difference among groups. Plaque volume at baseline was greater in CKD 4-5 than the other groups. (p =0.009). At follow-up, plaque volume increased in CKD-3 (+ 4.6 mm3, p <0.001) and CKD 4-5 (+ 9.8 mm3, p <0.001), but decreased in CKD-1 (- 5.4 mm3, p =0.002) and CKD-2 (- 3.2 mm3, p=0.001). Serial plaque volume change was correlated with eGFR. (Y= - 0.2X +11.4, p<0.0001). IB-IVUS analysis showed that lipid plaque increased in CKD-3 (+ 4.6 mm3, p <0.001) and CKD 4-5 (+ 5.4 mm3, p <0.001), but significantly decreased in CKD-2 (- 2.7 mm3, p <0.05) at follow-up. Fibrotic plaque also increased in CKD 4-5 (+ 3.4 mm3, p <0.001), whereas it decreased in CKD-1 (- 3.3 mm3, p <0.05). Multivariate models revealed CKD staging is an independent predictor of plaque progression.
Conclusions: Despite standard medical therapy after culprit PCI, late stages of CKD were associated with coronary plaque progression characterized by greater lipid and fibrotic plaque volumes in NCL. Strict risk management should be required to prevent subsequent coronary events in those patients.
Author Disclosures: K. Kashiyama: None. S. Sonoda: None. H. Takami: None. R. Anai: None. Y. Muraoka: None. Y. Tsuda: None. M. Araki: None. Y. Otsuji: None.
- © 2014 by American Heart Association, Inc.