Impact of chronic kidney disease on the extent and severity of coronary plaque burden in general population: evaluation by Coronary CT angiography

Abstract

Abstract Background Previous studies have reported an association between chronic kidney disease (CKD) and coronary artery calcification. However, data on the quantitative assessment of coronary plaques in patients with CKD without overt coronary events are limited. The current study aimed to examine the association of CKD with the composition and burden of coronary atherosclerotic plaques in the general population. Methods The authors studied 1747 subjects who underwent coronary computed tomographic angiography as part of health checkup. Atherosclerotic plaque burden was measured by atheroma burden obstructive score (ABOS), segment involvement score (SIS), and segment stenosis score (SSS). Based on the number of segments with plaques, the extent of coronary artery disease (CAD) was categorized as non-extensive (SIS ≤4 or SSS <7) or extensive (SIS >4 or SSS ≥7). Results In all participants, calcified plaques were more frequently detected than mixed or non-calcified plaques. Regarding the grade of luminal stenosis, obstructive plaques (> 50% stenosis) were more frequently observed in the CKD group than in the non-CKD group. Individuals with CKD had significantly higher ABOS, SIS, and SSS than those without CKD. After adjusting for traditional risk factors, CKD was independently associated with obstructive mixed plaques (odds ratio [OR]: 1.937, P=0.012) and extensive CAD (SIS >4 [OR: 1.645; P=0.043]; SSS ≥7 [OR: 1.660; P=0.045]). Subgroup analyses revealed no significant heterogeneity between CKD and obstructive mixed plaques in each subgroup. However, a more prominent association between CKD and the risk of extensive CAD was observed in subjects aged <65 years. Conclusions Renal dysfunction was independently associated with obstructive mixed plaque pattern and increased atherosclerotic plaque burden. Our findings support that CKD is a major risk factor for the development of obstructive and extensive CAD.