Incidence and prognostic impact of the calcified nodule in coronary artery disease patients with end-stage renal disease on dialysis

Okamura, Akihiko; Okura, Hiroyuki; Iwai, Saki; Sakagami, Azusa; Kamon, Daisuke; Hashimoto, Yukihiro; Ueda, Tomoya; Soeda, Tsunenari; Watanabe, Makoto; Saito, Yoshihiko

doi:10.1007/s00380-022-02076-1

Cited by 7 publications

(9 citation statements)

References 45 publications

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“…Moreover, Lee et al reported that hemodialysis is the independent predictor of CN 15) . In patients with end-stage renal disease, duration of hemodialysis was significantly longer in patients with CN than in patients without CN 30) . There would be a strong correlation between CN and hemodialysis.…”

Section: Worse Clinical Outcomes Of Cnmentioning

confidence: 89%

Clinical Outcomes and Unique Restenosis of Calcified Nodule in Heavily Calcified Coronary Artery

Jinnouchi

Sakakura

Taniguchi

et al. 2023

JAT

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Aims: Calcified nodule (CN) has been known as the advanced stage of coronary calcification. However, clinical outcomes following percutaneous coronary intervention (PCI) to CN remain unknown. This study aimed to compare clinical outcomes, including target lesion revascularization (TLR), between calcified coronary lesions with and without CN. Methods: Two hundred forty-nine lesions undergoing intravascular ultrasound-guided PCI with rotational atherectomy (RA) were enrolled and divided into the CN group (n=100) and the non-CN group (n=149) according to the presence of CN. The cumulative incidence of clinically driven TLR (CD-TLR) and the reasons for CD-TLR were compared between the CN and non-CN groups.Results: The incidence of CD-TLR was significantly higher in the CN group than in the non-CN group. In the landmark analysis at 1 year, the CN group showed a significantly higher incidence of CD-TLR within 1 year. However, the incidence of CD-TLR beyond 1 year was numerically lower in the CN group than in the non-CN group. In the multivariate Cox hazard model, CN was significantly associated with CD-TLR. In the CN group, in-stent CN was the major reason for CD-TLR (52%) and was observed mainly within 1 year (90%). Conclusions:In the heavily calcified lesions requiring RA, CN was the factor associated with the higher rate of CD-TLR especially within 1 year. The timing of CD-TLR in lesions with CN may indicate that the process of CN protruding through the struts was progressed monthly.

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Section: Worse Clinical Outcomes Of Cnmentioning

confidence: 89%

Clinical Outcomes and Unique Restenosis of Calcified Nodule in Heavily Calcified Coronary Artery

Jinnouchi

Sakakura

Taniguchi

et al. 2023

JAT

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“…We found no statistically significant differences regarding OCT-defined plaque types in renal dysfunction vs no renal dysfunction patients. Several studies have found more frequent calcifications among patients with CKD [ 14 – 16 ]. Of note, however, those studies concentrated on patients with end-stage renal disease and hemodialyzed patients, whereas our study concentrated on people with mild-to-moderate renal dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…Lipid-rich plaques were more frequent in the CKD group ( P =0.01) compared to the non-CKD group, but no differences were found in calcification arcs, whereas when compared to the ESKD group calcifications were less prevalent ( P =0.025) [ 71 ]. Okamura et al came to the conclusion that the amount of calcium in OCT was positively correlated with the duration of dialysis and consequently the duration of CKD [ 16 ], and the deterioration of renal function and advancement into the ESKD category was positively correlated with the progression of calcifications [ 71 ]. There were also contrasting results in terms of lipid arc.…”

Section: Discussionmentioning

confidence: 99%

A 5-Year Follow-Up Study of 100 Patients with 118 Intermediate Coronary Artery Lesions Evaluated by Fractional Flow Reserve and Intravascular Imaging Stratified According to Renal Function

Baruś,

Hunia,

Kaczorowski

et al. 2024

Med Sci Monit

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Background Progression of chronic coronary syndrome (CCS) is influenced by chronic kidney disease (CKD). This 5-year follow-up study aimed to assess 100 patients with 118 intermediate coronary artery lesions evaluated by fractional flow reserve (FFR) and intravascular imaging stratified according to renal function. Material/Methods This prospective study enrolled patients with intermediate coronary stenosis identified by coronary angiogram. Patients with severe renal dysfunction (estimated glomerular filtration rate (eGFR) <45 ml/min/1.73 m 2 ) were excluded from the study. The remaining were divided into 2 groups according to eGFR: 45–60 ml/min/1.73 m 2 for mild-to-moderate renal dysfunction and >60 ml/min/1.73 m 2 for no renal dysfunction. We analyzed intermediate-grade stenoses (40–80% as assessed in coronary angiography) with the use of optical coherence tomography (OCT), FFR, and intravascular ultrasound (IVUS). Results Renal dysfunction patients were older (67.7±8.1 vs 63.6±9.7 years, P =0.044). Lesion characteristics, including plaque type and minimal lumen area in OCT, showed no significant differences between the renal dysfunction and no renal dysfunction groups. Thin-cap fibroatheroma, calcific plaques, lipidic plaques, and fibrous plaques had similar prevalence. FFR values and IVUS parameters did not significantly differ between the groups. Over a 5-year follow-up, individuals with mild-to-moderate renal dysfunction had an elevated risk of all-cause mortality and major adverse cardiovascular events in multivariate analyses adjusted for age and sex. Conclusions Mild-to-moderate renal dysfunction was not associated with significant differences in OCT- and IVUS-derived plaque morphology nor with functional indices characterizing intermediate-grade coronary stenoses. Renal dysfunction was related to a higher risk of all-cause mortality and major adverse cardiovascular events prevalence in 5-year follow-up.

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“…CAD in dialysis patients was characterized by multiple-vessel disease, including diffuse vessel disease, small vessel disease, calcification, and left main coronary artery. Another study reported that calcified nodule (CN) was frequently (about 60%) detected by optical coherence tomography (OCT) in CAD patients on dialysis ( 22 ). CN is one of the plaque characteristics of patients with ACS or sudden cardiac deaths and associated with major adverse cardiovascular events (MACEs) after PCI ( 23 ).…”

Section: Discussionmentioning

confidence: 99%

Comparison of revascularization with conservative medical treatment in maintenance dialysis patient with coronary artery disease: a systemic review and meta-analysis

Zheng

Wang

Zhong

2023

Front. Cardiovasc. Med.

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BackgroundThe primary cause of death among maintenance dialysis patients is coronary artery disease (CAD). However, the best treatment plan has not yet been identified.MethodsThe relevant articles were retrieved from various online databases and references from their inception to October 12, 2022. The studies that compared revascularization [percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)] with medical treatment (MT) among maintenance dialysis patients with CAD were selected. The outcomes evaluated were long-term (with a follow-up of at least 1 year) all-cause mortality, long-term cardiac mortality, and the incidence rate of bleeding events. Bleeding events are defined according to TIMI hemorrhage criteria: (1) major hemorrhage, intracranial hemorrhage or clinically visible hemorrhage (including imaging diagnosis) with decrease of hemoglobin concentration ≥5 g/dl; (2) minor hemorrhage, clinically visible bleeding (including imaging diagnosis) with a drop in hemoglobin of 3–5 g/dl; (3) minimal hemorrhage, clinically visible bleeding with hemoglobin drop <3 g/dl. In addition, revascularization strategy, CAD type, and the number of diseased vessels were considered in subgroup analyses.ResultsA total of eight studies with 1,685 patients were selected for this meta-analysis. The current findings suggested that revascularization was associated with low long-term all-cause mortality and long-term cardiac mortality but a similar incidence rate of bleeding events compared to MT. However, subgroup analyses indicated that PCI is linked to decreased long-term all-cause mortality compared to MT but CABG did not significantly differ from MT in terms of long-term all-cause mortality. Revascularization also showed lower long-term all-cause mortality compared to MT among patients with stable CAD, single-vessel disease, and multivessel disease but did not reduce long-term all-cause mortality among patients with ACS.ConclusionLong-term all-cause mortality and long-term cardiac mortality were reduced by revascularization in comparison to MT alone in patients undergoing dialysis. Larger randomized studies are needed to confirm the conclusion of this meta-analysis.

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Incidence and prognostic impact of the calcified nodule in coronary artery disease patients with end-stage renal disease on dialysis

Cited by 7 publications

References 45 publications

Clinical Outcomes and Unique Restenosis of Calcified Nodule in Heavily Calcified Coronary Artery

Clinical Outcomes and Unique Restenosis of Calcified Nodule in Heavily Calcified Coronary Artery

A 5-Year Follow-Up Study of 100 Patients with 118 Intermediate Coronary Artery Lesions Evaluated by Fractional Flow Reserve and Intravascular Imaging Stratified According to Renal Function

Comparison of revascularization with conservative medical treatment in maintenance dialysis patient with coronary artery disease: a systemic review and meta-analysis

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