Impact of renal function on coronary plaque composition

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Background : Recent studies have demonstrated that patients with chronic kidney disease are at high risk of atherosclerosis. Recently, coronary plaque components can be evaluated by integrated-backscatter intravascular ultrasound (IB-IVUS) and lipid-rich plaque is associated with vulnerable plaque. This aim of the study was to investigate relationship between renal function and tissue characterization of coronary plaque composition at the target stenotic site for percutaneous coronary intervention (PCI).Methods : We prospectively performed IB-IVUS before elective PCI to 89 consecutive patients with stable angina. According to estimated glomerular filtration rate (eGFR), they were divided into the two groups (eGFR<60 ml/min/1.73m2 or eGFR≧60 ml/min/1.73m2). The tissue characteristics of the coronary plaque at each target stenotic site were evaluated by three-dimensional IB-IVUS just before PCI procedure.Results : Patients with eGFR<60 ml/min/1.73m2 had higher percentage of lipid volume and lower percentage of fibrous volume compared to patients with eGFR≧60 ml/min/1.73m2 on the 3-D IB-IVUS images (36.7±10.6% vs.28.7±9.3%, P<0.001 and 59.1±8.7% vs. 66.3±8.3%, P<0.001, respectively). eGFR showed a significant negative correlation with lipid volume and had a significant positive correlation with fibrous volume in coronary plaques(r=-0.44, p<0.0001, and r=0.46, p<0.0001, respectively)Conclusions : Impaired renal function was related to higher percentage of lipid volume and lower percentage of fibrous volume in coronary plaque. Our findings may explain the increasing risk of cardiovascular events in patients with renal dysfunction.