title: Chronic kidney disease predicts coronary plaque vulnerability: an optical coherence tomography study.
abstract: OBJECTIVE
  The addition of cystatin C to creatinine in calculating the estimated glomerular filtration rate (eGFR) is known to improve the risk prediction for cardiovascular events. We sought to investigate the associations between eGFRs calculated by three Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations and coronary plaque phenotype by optical coherence tomography.
  
  
  METHODS
  We analyzed 181 nonculprit plaques from 116 coronary artery disease patients. For each patient, the eGFR was calculated using the CKD-EPIcreatinine, CKD-EPIcystatin C, and CKD-EPIcombination equations. Patients were divided into three categories according to the eGFR calculated by each equation (≥90, 60-89, and <60 ml/min/1.73 m).
  
  
  RESULTS
  The prevalence of thin-cap fibroatheroma (TCFA) was correlated inversely with eGFR calculated using CKD-EPIcystatin C and CKD-EPIcombination equations, but not using the CKD-EPIcreatinine equation. The best cut-off values of eGFR calculated by these two equations for differentiating TCFA were 83 and 84 ml/min/1.73 m, respectively. Compared with the CKD-EPIcreatinine equation, patients who were reclassified upward or downward categories by the CKD-EPIcystatin C equation were associated with consistently lower [adjusted odds ratio=0.27, 95% confidence interval (CI), 0.08-0.86] and higher (adjusted odds ratio=2.41, 95% CI, 1.08-5.41) prevalence for TCFA, respectively. The net reclassification improvement with cystatin C, compared with creatinine, was 0.45 (95% CI, 0.20-0.69) for TCFA, 0.38 (95% CI, 0.09-0.67) for thrombus, and 0.21 (95% CI, 0.00-0.42) for cholesterol crystals. Results were generally similar for the CKD-EPIcombination equation.
  
  
  CONCLUSIONS
  The use of cystatin C alone or in combination with creatinine, compared with creatinine alone, for GFR estimation strengthens the associations between the eGFR and prevalence of vulnerable plaque characteristics.
authors.affiliation: aDepartment of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China bMassachusetts General Hospital, Harvard Medical School, Cardiology Division, Boston, Massachusetts, USA.
authors.forename: Jiannan
authors.initials: J
authors.lastname: Dai
authors.forename: Lei
authors.initials: L
authors.lastname: Xing
authors.forename: Jingbo
authors.initials: J
authors.lastname: Hou
authors.forename: Haibo
authors.initials: H
authors.lastname: Jia
authors.forename: Sining
authors.initials: S
authors.lastname: Hu
authors.forename: Jinwei
authors.initials: J
authors.lastname: Tian
authors.forename: Lin
authors.initials: L
authors.lastname: Lin
authors.forename: Lulu
authors.initials: L
authors.lastname: Li
authors.forename: Yinchun
authors.initials: Y
authors.lastname: Zhu
authors.forename: Gonghui
authors.initials: G
authors.lastname: Zheng
authors.forename: Shaosong
authors.initials: S
authors.lastname: Zhang
authors.forename: Bo
authors.initials: B
authors.lastname: Yu
authors.forename: Ik-Kyung
authors.initials: IK
authors.lastname: Jang
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D016017:Odds Ratio; D010641:Phenotype; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D012422:Rupture, Spontaneous; D041623:Tomography, Optical Coherence
chemical_list: D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; D003404:Creatinine