title: Coronary atherosclerosis and risk of acute coronary syndromes in chronic kidney disease using angioscopy and the kidney disease: Improving Global Outcomes (KDIGO) classification.
abstract: OBJECTIVE
  This 8-year follow-up cohort study evaluated and compared the degree of coronary atherosclerosis in chronic kidney disease (CKD) according to the Kidney Disease: Improving Global Outcomes (KDIGO) classification using multivessel angioscopy and investigated the impact of the vulnerability of coronary arteries on the relationship between the classification and risk of acute coronary syndromes (ACS).
  
  
  METHODS
  We studied 89 coronary artery disease patients who underwent angioscopic observation of multiple coronary arteries. The patients were divided into 3 groups: Risk 0, 1, and 2 were equivalent to low risk, moderately high risk, and high and severely high risk, respectively. We examined the frequencies of complex and yellow plaques. Furthermore, we followed all patients for de novo ACS, dividing into two groups according to the existence of vulnerable coronary atherosclerosis (VCA) based on angioscopic findings.
  
  
  RESULTS
  The number of yellow plaques per vessel, maximum yellow grade, number of complex plaques per vessel, and cumulative incidence of ACS in all patients were significantly associated with Risk grade progression (p < 0.05 for trend). Among the patients with VCA, Risk 2 had a higher incidence of ACS than Risk0 (p < 0.014) and Risk 1 (p < 0.007), whereas Risk 0 and Risk 1 had similar outcomes. Among the patients without VCA, no de novo ACS events were seen regardless of the Risk group.
  
  
  CONCLUSIONS
  Coronary atherosclerosis progressed in the early stages of CKD, and once it reached to a vulnerable stage, advanced CKD patients had a synergistically increased risk of ACS.
authors.affiliation: Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Kurihara
authors.affiliation: Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan. Electronic address: okamatsu@nms.ac.jp.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Okamatsu
authors.affiliation: Division of Cardiology, Nippon Medical School, Tokyo, Japan.
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Mizuno
authors.affiliation: Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan.
authors.forename: Masamichi
authors.initials: M
authors.lastname: Takano
authors.affiliation: Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan.
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Kobayashi
authors.affiliation: Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Munakata
authors.affiliation: Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Murakami
authors.affiliation: Division of Cardiology, Nippon Medical School, Tokyo, Japan.
authors.forename: Shigenobu
authors.initials: S
authors.lastname: Inami
authors.affiliation: Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan.
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Ohba
authors.affiliation: Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan.
authors.forename: Noritake
authors.initials: N
authors.lastname: Hata
authors.affiliation: Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Seino
authors.affiliation: Division of Cardiology, Nippon Medical School, Tokyo, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Shimizu
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D000368:Aged; D017546:Angioscopy; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000473:pathology*; D003331:Coronary Vessels / Q000473:pathology*; D016208:Databases, Factual; D018450:Disease Progression; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012422:Rupture, Spontaneous; D013997:Time Factors
keywords: Acute coronary syndromes; Angioscopy; Atherosclerosis; Chronic kidney disease