Prevalence of Significant Coronary Artery Stenosis and Relationship with Carotid Maximum Intima-Media Thickness in Asymptomatic Patients with Moderate-to-Severe Chronic Kidney Disease: A Single-Center, Prospective, Cross-Sectional Study

Aim: Coronary artery disease is a major cause of mortality in patients with chronic kidney disease (CKD); however, the actual burden of asymptomatic coronary artery stenosis in patients with advanced-stage CKD remains unclear. We investigated the prevalence and associated factors of significant coronary artery stenosis (≥ 50%) in asymptomatic patients with moderate-to-severe (stage G3– 5) CKD. Furthermore, we evaluated the usefulness of carotid maximum intima-media thickness (IMT) in predicting significant coronary artery stenosis in these patients. Methods: We enrolled 128 patients (men: 68.0%; mean age: 70.3± 11.2 years; mean estimated glomerular filtration rate: 37.6± 12.9 mL/min/1.73 m 2 ) in a prospective, cross-sectional study. The presence and severity of coronary artery stenosis was evaluated by coronary magnetic resonance angiography. Carotid maximum-IMT was also evaluated by carotid ultrasonography. Factors which were associated with the presence of significant coronary artery stenosis were explored by multivariable logistic regression analysis. The diagnostic accuracy of carotid maximum-IMT for detecting significant coronary artery stenosis was explored by receiver operating characteristic (ROC) curve analysis. Results: Seventy-six patients (60%) had significant coronary artery stenosis. Univariable analyses showed that age, body mass index, high-density lipoprotein cholesterol, glycated hemoglobin, C-reactive protein, and carotid maximum-IMT were associated with the presence of significant coronary artery stenosis. However, multivariable logistic regression analysis revealed that only carotid maximum-IMT (odds ratio: 4.86; P < 0.001) was associated with the presence of significant coronary artery stenosis. The ROC curve of carotid maximum-IMT was significant ( P < 0.001), with an area under the curve of 0.788 (cut-off value, 1.5 mm; sensitivity, 0.84; specificity, 0.58). Conclusion: The prevalence of significant coronary artery stenosis was high (60%) in patients with moderate-to-severe CKD. Carotid maximum-IMT was the primary factor associated with the presence of significant coronary artery stenosis and might be a surrogate marker for significant coronary artery stenosis in these patients.