Abstract: TH-OR039

Subclinical Coronary Artery Calcification Predicts Future Risk of Acute Coronary Syndrome Among Non-Dialysis CKD: A 5-Year Prospective Analysis

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 303 CKD: Epidemiology, Outcomes - Cardiovascular

Authors

  • Wang, Angela Yee Moon, University of Hong Kong, Queen Mary Hospital, HONG KONG, China
  • Wu, Henry Hon Lin, University of Hong Kong, Queen Mary Hospital, HONG KONG, China
  • Cheung, Sharon Yui Ling, University of Hong Kong, Queen Mary Hospital, HONG KONG, China
  • Wong, Sharon Shee yin, University of Hong Kong, Queen Mary Hospital, HONG KONG, China
  • Yau, Yat Y., Biomedical Imaging Center, Hong Kong, Hong Kong, Hong Kong
  • Ryskaliyeva, Sharbat, University of Hong Kong, Queen Mary Hospital, HONG KONG, China
Background

Vascular calcification is highly prevalent in chronic kidney disease (CKD) and is considered to be largely a medial type of arterial calcification, secondary to deranged mineral metabolism as a result of impaired kidney function. This is in contrast to studies in the general population suggesting that vascular calcification is a marker of atherosclerotic burden. The current study aims to determine if subclinical coronary artery calcification may predict future risk of acute coronary syndrome (ACS) in non-dialysis CKD.

Methods

Two hundred and seventy-two asymptomatic CKD 3-5 subjects with no known history of coronary artery disease (age: 60 ± 10 years, 56% men) were recruited from a University Teaching Hospital. All subjects underwent plain multi-slice computed tomography to estimate coronary artery calcium score (CACS) and blood collection.

Results

All subjects were followed up prospectively for a median duration of 69 months, during which 18% of subjects developed ACS or died from other causes. Having a CACS ≥ 400 was independently associated with an increased risk of ACS and mortality [adjusted hazard ratio (HR), 4.66, 95% confidence intervals (CI), 1.37 - 15.83] controlling for Framingham risk factors. Further adjusting for eGFR, proteinuria, hemoglobin, serum albumin, phosphate, low density lipoprotein-cholesterol, and C-reactive protein did not alter the independent association between CACS ≥ 400 with ACS and death [adjusted HR, 4.31, 95% CI, 1.22 – 15.27]. The area under the receiver-operator characteristics curve for CACS in predicting a composite outcome of ACS and mortality in CKD was 0.74 (95% CI, 0.67 - 0.82). Having a CACS ≥ 400 showed a specificity of 86% in predicting a future risk of ACS and mortality.

Conclusion

This study for the first time demonstrates the importance of subclinical coronary artery calcification in predicting future risk of ACS and mortality among asymptomatic non-dialysis CKD subjects. These novel findings suggest that coronary artery calcification reflects atherosclerotic disease burden other than 'mineral stress' among CKD subjects. The potential value of CACS as a screening tool to early identify CKD subjects at future risk of ACS warrant further large scale evaluation.

Funding

  • Commercial Support