Roles of Serum Total P-Cresylsulfate and Chronic Kidney Disease in Coronary Atherosclerotic Burden in Acute Coronary Syndrome Patients

Objectives: Cardiovascular disease is prevalent among patients with chronic kidney disease (CKD). Additionally, patients with CKD have elevated levels of p-cresylsulfate (PCS), which have been linked to vascular impairment and hypercoagulability in the CKD population. The aim of this study was to evaluate the clinical significance of CKD in acute coronary syndrome (ACS) patients and to investigate whether a significant correlation exists between CKD, total PCS, and coronary atherosclerotic burden in ACS patients. Methods: 221 consecutive ACS patients and 93 non-coronary artery disease controls were tested to establish total serum PCS concentration levels, which were measured using ultra performance liquid chromatography (UPLC). Thereafter, their associations with angiographic indices of the number of diseased vessels and modified Gensini score were estimated. CKD was defined as an estimated glomerular filtration rate (eGFR) of <60 ml/min per 1.73 m(2). Results: ACS patients had increased median total serum PCS levels related to patients with normal coronary arteries. When the patients were divided into 4 groups on the basis of their CKD status and total PCS level, patients with high total PCS (> 1.26 mg/L) levels and CKD had significantly increased numbers of diseased vessels and Gensini score. By multivariate analysis, high total serum total PCS level and CKD were independently associated with ACS. Furthermore, the odds ratio for stenotic vessel disease in the group with both CKD and high total PCS level was 4.100 relative to the group without CKD and a low total PCS level (p = 0.0003). Conclusion: Our study suggests that total PCS is related to the extent of coronary atherosclerosis, and might play a role in the consequence of plaque vulnerability in ACS patients with low eGFR.