Serum creatinine is independently associated with angiographic extent of coronary artery disease in patients with stable angina pectoris

Objective: Renal dysfunction has been shown to be linked to high risk for cardiovascular events. Even milder forms of creatinine elevation are associated with poor cardiovascular outcomes. We designed a retrospective study and searched the association of angiographic extent of coronary artery disease and creatinine levels in patients without overt renal dysfunction. Methods: We retrospectively reviewed 892 consecutive patients with typical stable angina pectoris (311 female with mean age of 62±10 years, 581 male with mean age of 56±11 years) at Türkiye Yüksek İhtisas Hospital and creatinine level ≤3 mg/dl without history of hemodialysis. Patients without overt renal disease were divided into 3 groups according to level of creatinine (Group A: Cr level 1.2 mg/dl, Group B: Cr level ≥1.2 and 1.5 mg/dl and Group C: Cr level ≥1.5 -≤3 mg/dl). Additionally after evaluation of coronary angiograms, patients were also classified according to those with high stenosis (stenosis score ≥16) and high extension scores (extension score 50%) versus low stenosis and low extension scores. Logistic regression analysis was performed to establish the clinical predictors of high total stenosis and high extension scores. Results: Each group of patients according to level of creatinine showed marked difference in terms of angiographic extent of coronary artery disease (p 0.001). Those in the highest creatinine group (≥1.5 mg/dl, but not above 3 mg/dl) had the highest total stenosis (17±6, p 0.001) and extension (78±25, p 0.001) scores irrespective of age and gender. Creatinine was shown to be significantly correlated with both stenosis and extension scores. Age (OR:1.035, 95% CI:1.016-1.054, p 0.0001), being male (OR:1.746, 95% CI: 1.135-2.685, p=0.011), presence of hypertension (OR:1.507, 95%CI: 1.005-2.25 p=0.047), presence of diabetes mellitus (OR: 1.865, 95%: 1.250-2.783, p=0.002), previous history of myocardial infarc- tion (OR: 1.624, 95%CI: 1.094-2.413, p=0.016), wall motion score index (OR:1.203, 95%CI: 1.108-1.305, p 0.0001) and creatinine (OR:4.037, 95%CI: 2.530-6.443, p 0.0001) level were found to be independent predictors of high total stenosis score. Furthermore, age (OR:1.042, 95%CI: 1.026-1.059, p 0.0001), being male (OR:2.587, 95%CI: 1.794-3.731, p 0.0001), presence of hypertension (OR:1.536, 95% CI:1.100-2.147, p=0.012), previous myocardial infarction (OR:6.183, 95%CI: 4.340-8.807, p 0.0001), total cholesterol/HDL ratio (OR:1.215, 95%CI: 1.114-1.327, p 0.0001) and creatinine (OR:3.814, 95%CI: 2.149-6.768, p 0.0001) were found to be independent predictors of high extension score. Conclusion: Serum creatinine seems to denote severity of angiographic extent of coronary artery disease in patients with typical chest pain.