Calcified and low-attenuation plaque burdens are associated with risk of all-cause mortality and major adverse cardiovascular events (MACE) in patients with chronic kidney disease (CKD). These results were published in Circulation: cardiovascular imaging.

Arterial calcification is accelerated in CKD. Thus, the leading cause of death and morbidity in patients with CKD is cardiovascular disease (CVD). The American College of Cardiology (ACC) recommends that kidney transplant candidates undergo cardiovascular testing.

Investigators at Gødstrup Hospital in Denmark obtained data for this study from Angiographic CT of Kidney Transplant Candidate (ACToR; ClinicalTrials.gov Identifier: NCT01344434) and a retrospective cohort of all patients who received coronary computed tomography angiography (CCTA) at Aarhus University Hospital between 2014 and 2019. Potential kidney transplant recipients (N=484) without major symptoms of Coronary artery disease (CAD) were assessed for mortality and MACE based on plaque burden, defined as percentage of atheroma volume. MACE was defined as cardiac death, myocardial infarction (MI), cardiac arrest with successful resuscitation, and late revascularization.

Patients had a mean age of 53.4 ± 11.7 years, 62.2% were men, 70.5% were on hemodialysis, they had been on dialysis for a median of 1.0 (IQR, 0.3-3, 0) years and 46.1% were 3 years or older. Heart Association (AHA) Risk Factors.

At CCTA, 26.5% of patients had no coronary plaques, 36.6% had visual stenosis, 57.2% had plaque with characteristics of high-risk plaque (HRP), 34.9% had HRP with 2 or more HRPC, 49.8% had low coronary plaque. attenuation plaques, 44.8% had positive remodeling, 19.0% had patchy calcifications, and 13.0% had a napkin ring sign.

During a median follow-up of 4.9 years, 71.3% received a kidney transplant, 14.3% died, and 11.6% had MACE.

The MACE rate was lower in patients without CAD (5.5%) than in those with stenosis (22.6%), HRP (23.1%), stenosis and HRP (29.8% ), high calcified plaque burden (24.2%) and low high burden. -attenuation plate load (21.1%). Similar trends in all-cause mortality were observed, in which mortality rates were lower without CAD (10.2%) than with CAD (range: 21.9%-27.2%).

In semiquantitative multivariate analysis, the risk of cardiac death or MI was associated with HRP (hazard ratio (HR), 2.41; P. = 0.019), tended to be related to the total coronary artery calcification score (HR: 1.12; P. = 0.061) and was inversely related to kidney transplantation (HR: 0.17; P. <.001). In the quantitative model, cardiac death and MI risk were associated with low attenuation (HR: 2.79; P. = 0.001) and calcified plaque loads (HR, 2.53; P. < 0.001) and was inversely related to kidney transplantation (HR: 0.13; P. <0.001) and stenosis diameter for 10% (HR, 0.77; P. =.035).

A combination of segment involvement score, coronary artery calcium score, visual stenosis, and HRP predicted MACE risk (C-statistic: 0.81; P. =.030).

These results may not be generalizable to patients with symptomatic coronary artery disease or younger people with renal insufficiency.

The study authors concluded: “In this large cohort of potential kidney transplant candidates undergoing CCTA as part of the pre-transplant evaluation, semi-qualitatively assessed HRPs were independently associated with high risk. from MACE. »

Disclosure: Some study authors have declared affiliations with biotechnology, pharmaceutical, and/or device companies. Please see the original reference for a complete list of author disclosures.

This article was originally published on The cardiology advisor