An optical coherence tomography comparison of coronary arterial plaque calcification in patients with end-stage renal disease and diabetes mellitus

Abstract

Background: Coronary arterial plaques in patients with end-stage renal disease (ESRD) are assumed to have increased calcification due to underlying renal disease or initiation of dialysis. This relationship may be confounded by comorbid type 2 diabetes mellitus (DM). Methods: From a single-center OCT registry, 60 patients were analyzed. Twenty patients with ESRD and diabetes (ESRD-DM) were compared to 2 groups of non-ESRD patients: 20 with and 20 without diabetes. In each patient, one 20 mm segment within the culprit vessel was analyzed. Results: ESRD-DM patients exhibited similar calcium burden, arc, and area compared to patients with diabetes alone. When compared to patients without diabetes, patients with diabetes exhibited a greater summed area of calcium (DM: Median 9.0, IQR [5.3–28] mm2 vs Non-DM: 3.5 [0.1–14] mm2, p = 0.04) and larger calcium deposits by arc (DM: Mean 45 ± SE 6.2° vs Non-DM: 21 ± 6.2°, p = 0.01) and area (DM: 0.58 ± 0.10 mm2 vs Non-DM: 0.26 ± 0.10 mm2, p = 0.03). Calcification deposits in ESRD-DM patients (0.14 ± 0.02 mm) and patients with diabetes (0.14 ± 0.02 mm) were more superficially located relative to patients without diabetes (0.21 ± 0.02 mm), p = 0.01 for both. Conclusions: Coronary calcification in DM and ESRD-DM groups exhibited similar burden, deposit size, and depth within the arterial wall. The increase in coronary calcification and cardiovascular disease events seen in ESRD-DM patients may not be secondary to ESRD and dialysis, but instead due to a combination of declining renal function and diabetes.

Impact of Hemodialysis Duration on Coronary Artery Calcification Among Hemodialysis Patients Who Underwent Percutaneous Coronary Intervention

“…Furthermore, the progression of CAC is more complex in the presence of end-stage renal failure. 23 Our study demonstrated that DM and HD duration are associated with severe CAC, consistent with these reports. In addition, DM control contributes to the progression of CAC.…”

Age‐Stratified Prevalence and Relative Prognostic Significance of Traditional Atherosclerotic Risk Factors: A Report from the Nationwide Registry of Percutaneous Coronary Interventions in Japan

“…Diabetes drives the multivessel disease progression and the diffused atherosclerotic plaque with calcium deposits are developed strongly as compared with other TARFs. 25 , 26 In a separate study, plaques in current smokers were found to be more strongly associated with high‐risk plaque, such as low‐attenuation plaques and napkin‐ring sign, as evident in coronary computed tomography angiography when compared with other TARFs. 27 The study using optical coherence tomography and intravascular ultrasound imaging also showed that current smokers had significantly more lipid‐rich plaque, thin‐cap fibroatheroma, and fewer plaques with calcium than former smokers and nonsmokers.…”