title: Coronary Plaque Characteristics in Hemodialysis-Dependent Patients as Assessed by Optical Coherence Tomography.
abstract: 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.
authors.affiliation: Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York; Department of Cardiology, National Heart Centre Singapore, Singapore.
authors.forename: Chee Yang
authors.initials: CY
authors.lastname: Chin
authors.affiliation: Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Matsumura
authors.affiliation: Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York.
authors.forename: Akiko
authors.initials: A
authors.lastname: Maehara
authors.affiliation: Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York.
authors.forename: Wenbin
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York.
authors.forename: Cheolmin Tetsumin
authors.initials: CT
authors.lastname: Lee
authors.affiliation: Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York.
authors.forename: Myong Hwa
authors.initials: MH
authors.lastname: Yamamoto
authors.affiliation: Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York; Department of Cardiology, National Center for Cardiovascular Disease, China Peking Union Medical College, Fuwai Hospital, Beijing, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Song
authors.affiliation: Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York.
authors.forename: Yasir
authors.initials: Y
authors.lastname: Parviz
authors.affiliation: Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York.
authors.forename: Nisha B
authors.initials: NB
authors.lastname: Jhalani
authors.affiliation: Division of Nephrology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York.
authors.forename: Sumit
authors.initials: S
authors.lastname: Mohan
authors.affiliation: Department of Surgery, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York.
authors.forename: Lloyd E
authors.initials: LE
authors.lastname: Ratner
authors.affiliation: Department of Surgery, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York.
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
authors.affiliation: Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.
authors.forename: Ori
authors.initials: O
authors.lastname: Ben-Yehuda
authors.affiliation: Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York.
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.affiliation: St. Francis Hospital and Heart Center, Roslyn, New York.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Shlofmitz
authors.affiliation: Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan.
authors.forename: Tsunekazu
authors.initials: T
authors.lastname: Kakuta
authors.affiliation: Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.affiliation: Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York. Electronic address: zaa2112@columbia.edu.
authors.forename: Ziad A
authors.initials: ZA
authors.lastname: Ali
mesh_terms: D000368:Aged; D060050:Angina, Stable / Q000150:complications / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000150:complications / Q000000981:diagnostic imaging*; D057216:Propensity Score; D006435:Renal Dialysis; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D061205:Vascular Calcification / Q000150:complications / Q000000981:diagnostic imaging*