Coronary Plaque Composition, Morphology, and Outcomes in Patients With and Without Chronic Kidney Disease Presenting With Acute Coronary Syndromes

Baber, Usman; Stone, Gregg W.; Weisz, Giora; Moreno, Pedro R.; Dangas, George; Maehara, Akiko; Mintz, Gary S.; Cristea, Ecaterina; Fahy, Martin; Xu, Ke; Lansky, Alexandra J.; Wennerblom, Bertil; Mathey, D; Templin, Barry; Zhang, Zhen; Serruys, Patrick W.; Mehran, Roxana

doi:10.1016/j.jcmg.2011.12.008

Cited by 99 publications

(68 citation statements)

References 38 publications

(39 reference statements)

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“…First, CKD accompanies accelerated and extensive atherosclerosis 28. Extensive subclinical coronary atherosclerosis in CKD patients might cause unpredictable progression of lesions that were not detected on angiography alone at the index procedure, and may affect the incidence of any revascularization, irrespective of angiographic CR and IR.…”

Section: Discussionmentioning

confidence: 99%

Differential Clinical Outcomes Between Angiographic Complete Versus Incomplete Coronary Revascularization, According to the Presence of Chronic Kidney Disease in the Drug‐Eluting Stent Era

Kim

Lee

Choi

et al. 2018

JAHA

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BackgroundThere are limited data regarding the prognostic impact of angiographic complete revascularization (CR) in patients with chronic kidney disease (CKD). We sought to investigate the differential prognostic impact of angiographic CR over incomplete revascularization (IR), according to the presence of CKD in the drug‐eluting stent era.Methods and ResultsBetween 2003 and 2011 at Samsung Medical Center, consecutive patients with multivessel disease were stratified by the presence of CKD (estimated glomerular filtration rate <60 mL/min per 1.73 m2) and classified according to angiographic CR (residual SYNTAX score=0) or IR. Clinical outcomes were compared between angiographic CR and IR, stratified by the presence of CKD. Primary outcome was patient‐oriented composite outcomes (POCO, a composite of all‐cause death, myocardial infarction, any revascularization) at 3 years. Inverse probability weighting was performed between the CR and IR groups. A total of 3224 patients were eligible for analysis: 2295 without CKD; 929 with CKD. Among non‐CKD patients, angiographic CR showed a significantly lower risk of POCO than IR (17.2% versus 21.7%, adjusted hazard ratio 0.76, 95% confidence interval, 0.62–0.95, P=0.014), mainly driven by a significantly lower risk of any revascularization. Among CKD patients, however, angiographic CR was associated with a significantly higher risk of POCO than IR (37.7% versus 28.4%, adjusted hazard ratio 1.42, 95% confidence interval, 1.08%–1.85%, P=0.011), mainly driven by a significantly higher risk of nonfatal target vessel myocardial infarction.ConclusionsAngiographic CR was associated with reduced risk of POCO than IR in patients without CKD; however, it was associated with a significantly higher risk of POCO and nonfatal myocardial infarction in CKD patients.

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Section: Discussionmentioning

confidence: 99%

Differential Clinical Outcomes Between Angiographic Complete Versus Incomplete Coronary Revascularization, According to the Presence of Chronic Kidney Disease in the Drug‐Eluting Stent Era

Kim

Lee

Choi

et al. 2018

JAHA

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“…28,29 Third, atherosclerotic plaques in patients with CKD are characterized by increased amounts of necrotic core and decreased fibrous volume, potentially enhancing plaque vulnerability. 30 In aggregate, findings of excess thrombotic risk in the absence Although it is well established that both ischemic and bleeding complications are high among patients with CKD after PCI, a novel finding from this study is that this risk is not uniform but varies substantially by the presence or absence of HPR. We found that the associations between HPR and clinical events were similar in magnitude and direction among those with and without CKD with no evidence of interaction.…”

Section: Discussionmentioning

confidence: 55%

Prevalence and Impact of High Platelet Reactivity in Chronic Kidney Disease

Baber

Mehran

Kirtane

et al. 2015

Circ: Cardiovascular Interventions

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A dverse cardiovascular events, including cardiac death and stent thrombosis, are markedly increased among those with versus without chronic kidney disease (CKD) after percutaneous coronary intervention (PCI).1-3 Residual atherothrombotic risk remains excessive among such patients even when treated with contemporary pharmacotherapy or novel stent platforms, including second-generation drug-eluting stents (DES). 4,5 Despite the strong epidemiological links between renal impairment and thrombotic risk, underlying causal and mechanistic insights have not been fully elucidated.High platelet reactivity (HPR) to adenosine diphosphate during clopidogrel therapy has also emerged as a strong and Background-Chronic kidney disease (CKD) is associated with increased rates of adverse events after percutaneous coronary intervention. We sought to determine the impact of CKD on platelet reactivity in clopidogrel-treated patients and whether high platelet reactivity (HPR) confers a similar or differential risk for adverse events among patients with CKD and non-CKD. Methods and Results-We performed a post hoc analysis of the Assessment of Dual Antiplatelet Therapy With DrugEluting Stents (ADAPT-DES) registry, which included 8582 patients undergoing percutaneous coronary intervention with drug-eluting stents and platelet function testing using the VerifyNow assay. We compared HPR and its impact on ischemic and bleeding events >2 years among patients with CKD and non-CKD. Patients with CKD (n=1367) were older, more often female, diabetic, and had lower ejection fraction compared with their non-CKD counterparts (n=7043). Although HPR prevalence increased with worsening renal function in unadjusted analyses, these associations were no longer present after adjustment. Major adverse cardiac event rates at 2 years among those without CKD or HPR, HPR alone, CKD alone, and both CKD and HPR were 9.0%, 11.2%, 13.3%, and 17.5%, respectively (P<0.001). Associations between HPR and adverse events were uniform across CKD strata without evidence of interaction. Conclusions-HPR is more common among those with versus without CKD, an association that is attributable to confounding risk factors that are more prevalent in CKD. The impact of HPR on ischemic and bleeding events is similar irrespective of CKD status. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00638794.(Circ Cardiovasc Interv. 2015;8:e001683.

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“…21 The pathophysiology in ACS patients with underlying renal dysfunction has been studied 22 Lesions in the coronaries of patients with renal dysfunction were found to be longer with more luminal encroachment and have higher plaque burden compared to coronaries of non renal dysfunction patients. Coronary plaque composition assessed with radio frequency IVUS depicted greater necrotic core with dense calcium and less fibrous tissue, all these changes make the coronary plaque less stable.…”

Section: Discussionmentioning

confidence: 99%

Renal Dysfunction in Patients With Acute Coronary Syndrome (Acs) at a Tertiary Care Hospital

Ijaz

Saad

et al. 2017

TPMJ

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ABSTRACT… Objectives:To determine the frequency of renal dysfunction in patients with acute coronary syndrome at a tertiary care hospital. Study design: Descriptive Cross-sectional study. Setting: Department of Cardiology, Nishtar Hospital Multan. Duration of study: Six months from November 2016 to May 2017. Subjects and Methods: Consecutive 285 patients who met inclusion criteria of our study were enrolled from department of Cardiology, Nishtar Hospital Multan. History was taken and relevant investigations were done. Computer based formula for MDRD eGFR was used to calculate eGFR in our patients. All these findings were entered in pre-designed, pre -tested study questionnaire. Data was entered and analyzed using computer based software SPSS version 20. All the quantitative variables of the study (such as age, serum creatinine level, GFR value) were calculated for mean and standard deviation. Frequencies and percentages were calculated for categorical variables like gender, residential area, socioeconomic status, level of education, H/O diabetes, H/O hypertension, H/O smoking and family history of IHD etc. Results: We studied 285 patients of acute coronary syndrome admitted in Cardiology department of Nishtar Hospital Multan, 210 (73.7%) were male and 75 (26.3%) female. One hundred eighty (63.2%) were from rural area and 105 (36.8%) were urban. One hundred thirty two (46.3%) were from low income group, 144 (50.5%) from middle income and 9 (3.2%) were from high income group. Two hundred four (71.6%) patients presented with chest pain and 72 (25.3%) presented with chest pain and shortness of breath. One hundred eight (37.9%) were hypertensive, 63 (32.6%) were diabetic, 135 (47.4%) were smokers and family history of IHD was present in 102 (35.8%) of the cases. eGFR was calculated by MDRD eGFR formula. eGFR was less than 30 ml/min/1.73 m 2 in 30 (10.5%) of the cases, 31-60 ml/ min/1.73 m 2 in 66 (23.2%) cases and eGFR was more than 60 ml/min/1.73 m 2 in 189 (66.3%) of the cases. Conclusion: The present study reveals that the substantial proportion of our study patients have underlying renal dysfunction. So eGFR estimation in ACS patients should be given due consideration. This will help in the management of these patients and may improve short and long term disease outcome. Further follow up studies especially in terms of morbidity and mortality in this sub-group of patients are suggested.

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Coronary Plaque Composition, Morphology, and Outcomes in Patients With and Without Chronic Kidney Disease Presenting With Acute Coronary Syndromes

Cited by 99 publications

References 38 publications

Differential Clinical Outcomes Between Angiographic Complete Versus Incomplete Coronary Revascularization, According to the Presence of Chronic Kidney Disease in the Drug‐Eluting Stent Era

Differential Clinical Outcomes Between Angiographic Complete Versus Incomplete Coronary Revascularization, According to the Presence of Chronic Kidney Disease in the Drug‐Eluting Stent Era

Prevalence and Impact of High Platelet Reactivity in Chronic Kidney Disease

Renal Dysfunction in Patients With Acute Coronary Syndrome (Acs) at a Tertiary Care Hospital

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