Journal Article

Coronary Plaque Characteristics in Hemodialysis-Dependent Patients as Assessed by Optical Coherence Tomography

Shlofmitz, Richard A., Matsumura, Mitsuaki, Ben-Yehuda, Ori, Ratner, Lloyd E., Ali, Ziad A., Zhang, Wenbin, Chin, Chee Yang, Stone, Gregg W., Parviz, Yasir, Kakuta, Tsunekazu, Jhalani, Nisha B., Cohen, David J., Song, Lei, Maehara, Akiko, Yamamoto, Myong Hwa, Mohan, Sumit, Mintz, Gary S., Lee, Cheolmin Tetsumin

2017

Overview

Coronary arteries in patients with chronic kidney disease (CKD) have been shown to exhibit more extensive atherosclerosis and calcium. We aimed to assess characteristics of coronary plaque in hemodialysis (HD)-dependent patients using optical coherence tomography (OCT). This was a multicenter, retrospective study of 124 patients with stable angina who underwent OCT imaging. Sixty-two HD-dependent patients who underwent pre-intervention OCT for coronary artery disease were compared 1:1 with a cohort of patients without CKD, matched for age, diabetes mellitus, gender, and culprit vessel. Baseline characteristics were comparable. Pre-intervention OCT imaging identified 62 paired culprit, 53 paired non-culprit, and 19 paired distal vessel lesions. Lesion length, minimum lumen area, and area stenosis were similar between groups. The HD-dependent group had greater mean calcium arcs in culprit (54.3° vs 26.4°, p = 0.004) and non-culprit lesions (34.3° vs 24.5°, p = 0.02) and greater maximum calcium arc in distal vessel segments (101.6° vs 0°, p = 0.03). There were no differences in lipid arcs between groups. There was a higher prevalence of thin intimal calcium, defined as an arc of calcium >30° within intima <0.5 mm thick, in patients in the HD-dependent group (41.9% vs 4.8%, p <0.001). There was a higher prevalence of calcified nodules in the HD-dependent group (24.2% vs 9.7%, p = 0.049) but no differences in medial calcification or thin-cap fibroatheroma. In conclusion, in this OCT study, HD-dependent patients, compared with matched patients without CKD, had more extensively distributed coronary calcium and uniquely, a higher prevalence of non-atherosclerotic thin intimal calcium. This thin intimal calcium may cause an overestimation of calcium burden by intravascular ultrasound and may contribute to the lack of correlation between increased coronary artery calcification scores with long-term outcomes in patients with CKD.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Acute coronary syndromes / Aged / Angina, Stable - complications / Angina, Stable - diagnostic imaging / Angiography / Arteries / Arteriosclerosis / Atherosclerosis / Autopsy / Branches / Calcification / Calcification (ectopic) / Calcium / Cardiovascular / Cardiovascular disease / Cardiovascular diseases / Case-Control Studies / Computed tomography / Computer programs / Coronary artery / Coronary artery disease / Coronary Artery Disease - complications / Coronary Artery Disease - diagnostic imaging / Coronary Stenosis - complications / Coronary Stenosis - diagnostic imaging / Coronary vessels / Coronary Vessels - diagnostic imaging / Diabetes mellitus / End-stage renal disease / Epidermal growth factor receptors / Female / Fibrin / Glomerular filtration rate / Heart diseases / Hemodialysis / Humans / Kidney diseases / Kidney Failure, Chronic - complications / Kidney Failure, Chronic - therapy / Kidney transplantation / Lesions / Lipids / Male / Media / Medical imaging / Middle Aged / Mortality / Nodules / Optical Coherence Tomography / Plaque, Atherosclerotic - complications / Plaque, Atherosclerotic - diagnostic imaging / Propensity Score / Renal Dialysis / Renal insufficiency / Retrospective Studies / Statistical analysis / Tomography, Optical Coherence / Ultrasound / Vascular Calcification - complications / Vascular Calcification - diagnostic imaging / Volumetric analysis