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Although advanced and end-stage renal disease have been associated with increased arterial calcifications and adverse cardiovascular events, there is a paucity of data regarding the association of early stages of renal insufficiency and coronary calcifications. We hypothesized that patients with mild renal insufficiency have greater coronary calcification than those with normal renal function.
One hundred and fifty patients underwent optical coherence tomography (OCT) during coronary angiography for evaluation of acute coronary syndrome or stable angina. Estimated glomerular filtration rate (eGFR) was calculated based on the CKD-EPI Creatinine (2009) equation, including age, race, sex, and serum creatinine levels. Renal function was stratified according to the eGFR as normal (≥90 ml/min/1.73m2) [eGFR-Norm] or mildly reduced (60-89 ml/min/1.73m2) [eGFR-Reduced]. Calcification on OCT was defined as a plaque with sharp borders and no attenuation comprising at least a 90-degree arc of the circumference. Percentage (%) of frames with calcification were calculated for each vessel.
Compared to patients with eGFR-Norm, those with eGFR-Reduced had significantly higher % calcification: 26.6 ± 25.0% vs. 9.03 ± 15.4%, (p<0.0001). In order to evaluate the impact of renal function on calcification independent of age, calcification was evaluated in patients ≤ 55 years old (n=59). In this subgroup, compared to patients with eGFR-Norm, those with eGFR-Reduced had significantly higher % calcification: 16.2 ± 16% vs 6.01 ± 14.7%, (p< 0.02) despite having similar age: 47.5 ± 5.6 vs 44.9 ± 7.3 years, (p= 0.19). (Figure)
Even patients with mild renal insufficiency and coronary artery disease have greater coronary calcification than those with normal renal function. This observation may have implications for appropriate lesion preparation prior to percutaneous coronary interventions.
IMAGING: Imaging: Intravascular