Abstract: SA-PO924
Right Coronary Artery (RCA) Dominant Distribution of Coronary Artery Lesions in the Development of CKD Stage
Session Information
- CKD: Clinical, Outcomes, Trials - III
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Tsukada, Miho, Saitama Sekishinkai Hospital, Saitama, Japan
- Hayashi, Toshihide, Toho university ohashi medical center, Meguro, TOKYO, Japan
- Joki, Nobuhiko, TOHO University Ohashi Medical Center, Tokyo, Japan
- Gen, Shiko, Saitama Sekishinkai Hospital, Saitama, Japan
- Ikeda, Naofumi, Saitama Sekishinkai Hospital, Saitama, Japan
Background
It is reported that a more proximal lesions in RCA was observed in CKD patients compared with non-CKD patients (Kidney International (2009) 75, 80–87). CKD may affect the location and/or distribution of coronary atherosclerosis. The characteristics of coronary artery disease in CKD patients, however, have not entirely been clarified. We elucidate the relationship between the progression of CKD and the distribution of coronary artery stenosis diagnosed by coronary artery angiography.
Methods
Among the 13391 cases of coronary artery angiography performed in our hospital from 2003 to 2017, we characterized coronary artery lesions in predialytic phase of CKD patients. The inclusion criteria was the patients who had been treated with the first elective PCI. The patients with previous revascularization, acute myocardial infarction, unstable angina pectoris, coronary artery bypass imaging after coronary artery bypass grafting, or hemodialysis or unknown renal function were excluded in this study. Finally, 3268 CKD patients were enrolled into this study.
Results
The average age was 71 (64-77) years, and average eGFR was 65 (53-77) ml/min. A single lesion was observed in 2168 cases and multiple lesions were observed in 1085 cases. location of the lesion was the right coronary artery (RCA) in 914 cases, left main trunk in 101 cases, left anterior descending artery (LAD) in 1832 cases, and left circumflex artery in 733 cases. The prevalence of RCA lesion significantly increases in parallel with the development of CKD stage, however this phenomenon disappeared in LAD and LCX lesion. In multivariate logistic regression analysis, odds ratios of RCA for stage 4 and 5 were 1.79 (C.I. 1.10 to 2.94, p=0.019) and 4.21 (C.I. 1.90 to 9.29, p<0.001) respectively compared with the reference of CKD1. After adjusting for age, male, diabetes, hypertension, and dyslipidemia, this strong association remained statistically significant.
Conclusion
It is still unclear the mechanism, it is possibility that progression pattern is different between three major coronary arteries. The deterioration of renal function may affect the progression of atherosclerosis more in RCA than LAD or LCX.