title: Coronary plaque composition, morphology, and outcomes in patients with and without chronic kidney disease presenting with acute coronary syndromes.
abstract: OBJECTIVE
  This study sought to evaluate the impact of chronic kidney disease (CKD) on coronary atherosclerotic plaque composition, morphology, and outcomes in patients with acute coronary syndromes (ACS).
  
  
  BACKGROUND
  CKD patients presenting with ACS are at increased risk for adverse events. Whether or not this increased risk reflects differences in coronary plaque composition remains unknown.
  
  
  METHODS
  In the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study, patients presenting with ACS in whom percutaneous coronary intervention was successful underwent 3-vessel grayscale and radiofrequency intravascular ultrasound imaging. Lesions were prospectively characterized, and patients were followed for a median of 3.4 years. We conducted a patient-level and lesion-level analysis of study participants by comparing intravascular ultrasound parameters of untreated nonculprit lesions in patients with and without CKD.
  
  
  RESULTS
  Patients with CKD (n = 73, 11.3%) were older, more often female and diabetic compared to those without CKD (n = 573). Nonculprit lesions in patients with (n = 280) versus without (n = 2,390) CKD were more likely to have plaque burden ≥ 70% (11.8% vs. 8.5%, p = 0.05) and minimal luminal area ≤ 4.0 mm(2) (25.9% vs. 19.2%, p = 0.005). The percentage of plaque comprised of necrotic core (15.0% vs. 13.0%, p = 0.0001) and dense calcium (8.2% vs. 6.4%, p < 0.0001) was higher while fibrous tissue (57.7% vs. 59.8%, p < 0.0001) was lower in CKD versus non-CKD lesions. The 3-year composite rate of cardiac death, cardiac arrest, or myocardial infarction (15.1% vs. 3.3%, p < 0.0001) was significantly higher in patients with than in those without CKD, although there were no differences in the rates of events adjudicated to nonculprit lesions.
  
  
  CONCLUSIONS
  Following percutaneous coronary intervention of all culprit lesions in ACS, patients with versus without CKD have more extensive and severe atherosclerosis remaining in their coronary tree with plaque composed of greater necrotic core and less fibrous tissue. These influences resulted in nonsignificantly different rates of non-culprit lesion-related adverse events, although cardiac death, arrest, or myocardial infarction were more common in patients with CKD.
authors.affiliation: Mount Sinai Medical Center, New York, New York, USA.
authors.forename: Usman
authors.initials: U
authors.lastname: Baber
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.forename: Giora
authors.initials: G
authors.lastname: Weisz
authors.forename: Pedro
authors.initials: P
authors.lastname: Moreno
authors.forename: George
authors.initials: G
authors.lastname: Dangas
authors.forename: Akiko
authors.initials: A
authors.lastname: Maehara
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.forename: Ecaterina
authors.initials: E
authors.lastname: Cristea
authors.forename: Martin
authors.initials: M
authors.lastname: Fahy
authors.forename: Ke
authors.initials: K
authors.lastname: Xu
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Lansky
authors.forename: Bertil
authors.initials: B
authors.lastname: Wennerblom
authors.forename: Detlef G
authors.initials: DG
authors.lastname: Mathey
authors.forename: Barry
authors.initials: B
authors.lastname: Templin
authors.forename: Zhen
authors.initials: Z
authors.lastname: Zhang
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D000368:Aged; D000789:Angina, Unstable / Q000401:mortality; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D002908:Chronic Disease; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D005060:Europe / Q000453:epidemiology; D005260:Female; D005355:Fibrosis; D006323:Heart Arrest / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality; D009336:Necrosis; D058226:Plaque, Atherosclerotic / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014481:United States / Q000453:epidemiology; D061205:Vascular Calcification / Q000175:diagnosis