Coronary Plaque Characteristics in Hemodialysis-Dependent Patients as Assessed by Optical Coherence Tomography

Chee Yang Chin; Mitsuaki Matsumura; Akiko Maehara; Wenbin Zhang; Cheolmin Tetsumin Lee; Myong Hwa Yamamoto; Lei Song; Yasir Parviz; Nisha B. Jhalani; Sumit Mohan; Lloyd E. Ratner; David J. Cohen; Ori Ben-Yehuda; Gregg W. Stone; Richard A. Shlofmitz; Tsunekazu Kakuta; Gary S. Mintz; Ziad A. Ali

doi:10.1016/j.amjcard.2017.01.022

Coronary Plaque Characteristics in Hemodialysis-Dependent Patients as Assessed by Optical Coherence Tomography

Chee Yang Chin
, Mitsuaki Matsumura
, Akiko Maehara
, Wenbin Zhang
, Cheolmin Tetsumin Lee
, Myong Hwa Yamamoto
, Lei Song
, Yasir Parviz
, Nisha B. Jhalani
, Sumit Mohan
, Lloyd E. Ratner
, David J. Cohen
, Ori Ben-Yehuda
, Gregg W. Stone
, Richard A. Shlofmitz
, Tsunekazu Kakuta
, Gary S. Mintz
, Ziad A. Ali

Research output: Contribution to journal › Article › peer-review

32 Scopus citations

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.

Original language	English
Pages (from-to)	1313-1319
Number of pages	7
Journal	American Journal of Cardiology
Volume	119
Issue number	9
DOIs	https://doi.org/10.1016/j.amjcard.2017.01.022
State	Published - 1 May 2017
Externally published	Yes

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10.1016/j.amjcard.2017.01.022

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Chin, C. Y., Matsumura, M., Maehara, A., Zhang, W., Lee, C. T., Yamamoto, M. H., Song, L., Parviz, Y., Jhalani, N. B., Mohan, S., Ratner, L. E., Cohen, D. J., Ben-Yehuda, O., Stone, G. W., Shlofmitz, R. A., Kakuta, T., Mintz, G. S., & Ali, Z. A. (2017). Coronary Plaque Characteristics in Hemodialysis-Dependent Patients as Assessed by Optical Coherence Tomography. American Journal of Cardiology, 119(9), 1313-1319. https://doi.org/10.1016/j.amjcard.2017.01.022

@article{639e1c12bef640738a24c1e19609efd8,

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.",

author = "Chin, \{Chee Yang\} and Mitsuaki Matsumura and Akiko Maehara and Wenbin Zhang and Lee, \{Cheolmin Tetsumin\} and Yamamoto, \{Myong Hwa\} and Lei Song and Yasir Parviz and Jhalani, \{Nisha B.\} and Sumit Mohan and Ratner, \{Lloyd E.\} and Cohen, \{David J.\} and Ori Ben-Yehuda and Stone, \{Gregg W.\} and Shlofmitz, \{Richard A.\} and Tsunekazu Kakuta and Mintz, \{Gary S.\} and Ali, \{Ziad A.\}",

note = "Publisher Copyright: {\textcopyright} 2017 Elsevier Inc.",

year = "2017",

month = may,

day = "1",

doi = "10.1016/j.amjcard.2017.01.022",

language = "English",

volume = "119",

pages = "1313--1319",

journal = "American Journal of Cardiology",

issn = "0002-9149",

publisher = "Elsevier Inc.",

number = "9",

}

Chin, CY, Matsumura, M, Maehara, A, Zhang, W, Lee, CT, Yamamoto, MH, Song, L, Parviz, Y, Jhalani, NB, Mohan, S, Ratner, LE, Cohen, DJ, Ben-Yehuda, O, Stone, GW, Shlofmitz, RA, Kakuta, T, Mintz, GS & Ali, ZA 2017, 'Coronary Plaque Characteristics in Hemodialysis-Dependent Patients as Assessed by Optical Coherence Tomography', American Journal of Cardiology, vol. 119, no. 9, pp. 1313-1319. https://doi.org/10.1016/j.amjcard.2017.01.022

TY - JOUR

T1 - Coronary Plaque Characteristics in Hemodialysis-Dependent Patients as Assessed by Optical Coherence Tomography

AU - Chin, Chee Yang

AU - Matsumura, Mitsuaki

AU - Maehara, Akiko

AU - Zhang, Wenbin

AU - Lee, Cheolmin Tetsumin

AU - Yamamoto, Myong Hwa

AU - Song, Lei

AU - Parviz, Yasir

AU - Jhalani, Nisha B.

AU - Mohan, Sumit

AU - Ratner, Lloyd E.

AU - Cohen, David J.

AU - Ben-Yehuda, Ori

AU - Stone, Gregg W.

AU - Shlofmitz, Richard A.

AU - Kakuta, Tsunekazu

AU - Mintz, Gary S.

AU - Ali, Ziad A.

PY - 2017/5/1

Y1 - 2017/5/1

N2 - 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.

AB - 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.

UR - https://www.scopus.com/pages/publications/85014379209

U2 - 10.1016/j.amjcard.2017.01.022

DO - 10.1016/j.amjcard.2017.01.022

M3 - Article

C2 - 28279437

AN - SCOPUS:85014379209

SN - 0002-9149

VL - 119

SP - 1313

EP - 1319

JO - American Journal of Cardiology

JF - American Journal of Cardiology

IS - 9

ER -

Coronary Plaque Characteristics in Hemodialysis-Dependent Patients as Assessed by Optical Coherence Tomography

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