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] mm(2) vs Non-DM: 3.5 [0.1-14] mm(2), p = 0.04) and larger calcium deposits by arc (DM: Mean 45 +/- SE 6.2 degrees vs Non-DM: 21 +/- 6.2 degrees, p = 0.01) and area (DM: 0.58 +/- 0.10 mm(2) vs Non-DM: 0.26 +/- 0.10 mm(2), 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.