Coronary Artery Calcification as a Marker for Coronary Artery Stenosis: Comparing Kidney Failure to the General Population

被引:5
作者
Jansz, Thijs T. [1 ,2 ]
Go, Meike H. Y. [3 ,4 ]
Hartkamp, Nolan S. [3 ,5 ]
Stoger, J. Lauran [3 ,6 ]
Celeng, Csilla [3 ]
Leiner, Tim [3 ]
de Jong, Pim A. [3 ]
Visseren, Frank J. L. [4 ]
Verhaar, Marianne C. [1 ,2 ]
van Jaarsveld, Brigit C. [7 ,8 ]
机构
[1] Univ Utrecht, Univ Med Ctr Utrecht, Dept Nephrol, Utrecht, Netherlands
[2] Univ Utrecht, Univ Med Ctr Utrecht, Dept Hypertens, Utrecht, Netherlands
[3] Univ Utrecht, Univ Med Ctr Utrecht, Dept Radiol, Utrecht, Netherlands
[4] Univ Utrecht, Univ Med Ctr Utrecht, Dept Vasc Med, UCC SMART Study Grp, Utrecht, Netherlands
[5] Amsterdam UMC, Dept Radiol, Amsterdam, Netherlands
[6] Leiden Univ, Med Ctr, Dept Radiol, Leiden, Netherlands
[7] Amsterdam UMC, Amsterdam Cardiovasc Sci, Dept Nephrol, Amsterdam, Netherlands
[8] Dianet Dialysis Ctr, Utrecht, Netherlands
关键词
STAGE RENAL-DISEASE; BEAM COMPUTED-TOMOGRAPHY; VASCULAR CALCIFICATION; CARDIOVASCULAR EVENTS; SCCT GUIDELINES; CT ANGIOGRAPHY; YOUNG-ADULTS; CALCIUM; RISK; MORTALITY;
D O I
10.1016/j.xkme.2021.01.010
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Rationale & Objective: The presence of calcified plaques in the coronary arteries is associated with cardiovascular mortality and is a hallmark of chronic kidney failure, but it is unclear whether this is associated with the same degree of coronary artery stenosis as in patients without kidney disease. We compared the relationship of coronary artery calcification (CAC) and stenosis between dialysis patients and patients without chronic kidney disease (CKD). Study Design: Observational cohort study. Setting & Participants: 127 dialysis patients and 447 patients without CKD with cardiovascular risk factors underwent cardiac computed tomography (CT), consisting of non-contrast-enhanced CT and CT angiography. CAC score and degree of coronary artery stenosis were assessed by independent readers. Predictor: Dialysis treatment. Outcome: Association between calcification and stenosis. Analytical Approach: Logistic regression to determine the association between CAC score and the presence of stenosis in a matched cohort and, in the full cohort, testing for the interaction of dialysis status with this relationship. Results: 112 patients were matched from each cohort, totaling 224 patients, using propensity scores for dialysis, balancing numerous cardiovascular risk factors. Median CAC score was 210 (IQR, 19-859) in dialysis patients and 58 (IQR, 0254) in patients without CKD; 35% of dialysis patients and 36% of patients without CKD had coronary artery stenosis >= 50%. Per each 100-unit higher CAC score, the matched dialysis cohort had significantly lower ORs for stenosis than the nonCKD cohort, 0.67 (95% CI, 0.52-0.83) for stenosis >= 50% and 0.75 (95% CI, 0.62-0.90) for stenosis >= 70%. Limitations: No comparison with the gold standard fractional flow reserve. Conclusions: Dialysis patients have higher risk for coronary artery stenosis with higher CAC scores, but this risk is comparatively lower than in patients without CKD with similar CAC scores. In dialysis patients, a high CAC score can easily be found without significant stenosis. Our data enable "translation" of degree of calcification to the probability of coronary stenosis in dialysis patients.
引用
收藏
页码:386 / +
页数:10
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