Significance of coronary artery calcification score (CACS) for the detection of coronary artery disease (CAD) in chronic dialysis patients
Introduction
Cardiovascular diseases including coronary artery disease (CAD) are a common cause of death in patients with end-stage renal disease (ESRD) [1], [2]. Once CAD occurs, the long-term prognosis is poor [3], [4]. The incidence of acute myocardial infarction in chronic dialysis patients is high compared to the general population [5]. Therefore, early detection and treatment of CAD is important in this population.
The coronary artery calcification score (CACS) measured by electron-beam computed tomography (EBCT) is useful for detecting CAD in the general population [6], [7], [8], [9], [10], but the clinical significance of CACS in ESRD patients is not known. The present study examined the relationship between CACS and CAD in ESRD patients on chronic dialysis therapy.
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Study design
We invited all patients undergoing EBCT and who were receiving regular hemodialysis (HD) at 4R dialysis units of Okinawa to participate in the study. These dialysis units are members of the Okinawa Dialysis Study group and the demographics and dialysis regimen have been published previously [11], [12]. EBCT examinations were performed at the Okinawa Chubu Tokushukai Hospital (Okinawa, Japan). The study period was from 1994 to 2005. A total of 314 patients underwent EBCT after informed consent
Results
We studied 76 patients (51 men, 25 women) with mean (S.D.) age at EBCT examination of 57.9 (12.1) years and mean (S.D.) duration of dialysis of 7.7 (6.6) years at the time of the EBCT examination. Among them, 50 (65.8%) patients were diagnosed with CAD (CAD group), and the remaining 26 patients did not have CAD (non-CAD group). The clinical background is summarized according to the presence or absence of CAD in Table 1.
Mean age at EBCT examination and mean age at start dialysis were higher in
Discussion
Vascular calcification involving the coronary arteries is often observed in ESRD patients. The relationship between vascular calcification and cardiovascular disease has been studied using radiographic methods in ESRD patients. Adragao et al. [14] reported that a vascular calcification score based on plain radiographic films of pelvis and hands of 123 ESRD patients predicted the cardiovascular risk of mortality, cardiovascular disease-related hospitalizations, and cardiovascular events.
Acknowledgements
We are grateful Drs. M. Matsuoka, M. Tozawa, S. Yoshi, N. Higa, and H. Afuso for their support.
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