Coronary Plaque Characteristics in Patients With Chronic Kidney Failure: Impact on Cardiovascular Events and Mortality.

IF 6.5 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Circulation: Cardiovascular Imaging Pub Date : 2024-10-01 Epub Date: 2024-09-30 DOI:10.1161/CIRCIMAGING.124.017066

Jonathan Nørtoft Dahl, Marie B Nielsen, Laust D Rasmussen, Per Ivarsen, Michelle C Williams, My Hanna Sofia Svensson, Henrik Birn, Morten Bøttcher, Simon Winther

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引用次数: 0

Abstract

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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慢性肾衰竭患者冠状动脉斑块的特征：对心血管事件和死亡率的影响

背景：在冠状动脉疾病患者中，具有高风险特征的冠状动脉斑块和低斑块负荷是与主要不良心血管事件（MACE）相关的独立指标。慢性肾衰竭患者可能具有不同的冠状动脉疾病特征。研究旨在评估慢性肾衰竭患者冠状动脉斑块特征和冠状动脉疾病程度与MACE和全因死亡率的关系：方法：纳入在肾移植前接受冠状动脉计算机断层扫描血管造影术的潜在肾移植候选者，该造影术是心脏筛查项目的一部分。我们对高危斑块和直径狭窄进行了半定量评估，并对冠状动脉钙化评分和斑块负担（粥样斑块体积百分比）进行了量化：在484名几乎没有冠状动脉疾病症状的慢性肾衰竭患者（平均年龄为53±12岁；62%为男性；32%正在透析）中，有56名（12%）患者发生了MACE，69名（14%）患者在中位4.9年的随访期间死亡。在 39 名（70%）发生急性心肌梗死的患者中存在高风险斑块。MACE 患者的钙化斑块负荷中位数为 3.7%，而无 MACE 患者的钙化斑块负荷中位数为 0.2%。低钙化斑块负荷中位数分别为0.3%和0.03%。在半定量分析中，高危斑块的存在和较高的冠状动脉钙化评分分别与MACE风险的增加有关（危险比（HR），2.0 [95% CI，1.0-3.7]；P=0.040；HR，1.2 [95% CI，1.0-1.3]；P=0.014）。两者均与全因死亡率无关。在量化分析中，钙化斑块和低衰减斑块负担水平的增加与MACE风险（HR，2.6 [95% CI，1.8-3.7]；PP=0.001[每个变量分别加倍]）和全因死亡率（HR，1.6 [95% CI，1.2-2.1]；P=0.002；HR，1.8 [95% CI，1.1-3.0]；P=0.028）相关：结论：在慢性肾衰竭患者中，钙化斑块和低衰减斑块负担与MACE和全因死亡率独立相关，而高风险斑块和冠状动脉钙化评分仅与MACE相关：URL：https://www.clinicaltrials.gov；唯一标识符：NCT01344434。

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来源期刊

Circulation: Cardiovascular Imaging 医学-核医学

CiteScore

6.30

自引率

2.70%

发文量

225

审稿时长

6-12 weeks

期刊介绍： Circulation: Cardiovascular Imaging, an American Heart Association journal, publishes high-quality, patient-centric articles focusing on observational studies, clinical trials, and advances in applied (translational) research. The journal features innovative, multimodality approaches to the diagnosis and risk stratification of cardiovascular disease. Modalities covered include echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging and spectroscopy, magnetic resonance angiography, cardiac positron emission tomography, noninvasive assessment of vascular and endothelial function, radionuclide imaging, molecular imaging, and others. Article types considered by Circulation: Cardiovascular Imaging include Original Research, Research Letters, Advances in Cardiovascular Imaging, Clinical Implications of Molecular Imaging Research, How to Use Imaging, Translating Novel Imaging Technologies into Clinical Applications, and Cardiovascular Images.