Quantitative coronary plaque characteristics on coronary computed tomography angiography and their prognostic value in patients with chronic kidney disease

Background: Chronic kidney disease (CKD) is associated with an increased risk of cardiovascular events. This study compared coronary plaque characteristics assessed by coronary computed tomography angiography (CCTA) between patients with and without CKD and evaluated their associations with major adverse cardiovascular events (MACE). Methods: This secondary analysis of the multicenter CREATION-CHINA cohort included patients with suspected coronary artery disease who underwent CCTA during 2016–2020. CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m 2 . Propensity score matching (1:3) used age, sex, hypertension, diabetes mellitus, smoking, family history of coronary artery disease, and hyperlipidemia. Quantitative plaque characteristics and perivascular fat attenuation index (FAI) were assessed. MACE comprised all-cause death, non-fatal myocardial infarction, stroke, or revascularization >90 days after CCTA. Cox models estimated hazard ratios (HRs) and 95% confidence intervals (CIs); analyses of CCTA-derived predictors were adjusted for age, body mass index, and hypertension. High plaque burden was defined as total plaque burden in the highest quartile. Results: After matching, 2,267 patients were included (588 with CKD and 1,679 without CKD). During a median follow-up of 3.47 years (interquartile range, 2.36–4.10), MACE occurred in 30 patients with CKD (5.1%) and 52 without CKD (3.1%; P=0.035). Patients with CKD had higher median total plaque volume (39.90 vs. 0 mm 3 ), median total plaque burden (8.83% vs. 0%), and prevalence of high-risk plaque (9.35% vs. 4.35%; all P<0.001). Among patients with CKD, lipid plaque burden (adjusted HR =1.107, 95% CI: 1.006–1.218; P=0.038) and high FAI (adjusted HR =4.027, 95% CI: 2.329–6.960; P<0.001) were independently associated with MACE. Compared with patients without CKD and with low plaque burden, those with CKD and high plaque burden had a higher risk of MACE (adjusted HR =6.153, 95% CI: 2.937–12.890; P<0.001). Conclusions: CKD was associated with greater coronary plaque burden and a higher incidence of MACE. Lipid plaque burden and high FAI were independently associated with MACE after adjustment for age, body mass index, and hypertension, supporting their potential role in cardiovascular risk assessment in patients with CKD.