title: Serum creatinine is independently associated with angiographic extent of coronary artery disease in patients with stable angina pectoris.
abstract: 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 infarction (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.
  
  
  CONCLUSIONS
  Serum creatinine seems to denote severity of angiographic extent of coronary artery disease in patients with typical chest pain.
authors.affiliation: Clinic of Cardiology, Türkiye Yüksek İhtisas Hospital, Ankara-Turkey. burcume@gmail.com.
authors.forename: Şule
authors.initials: Ş
authors.lastname: Korkmaz
authors.forename: Burcu
authors.initials: B
authors.lastname: Demirkan
authors.forename: Hakan
authors.initials: H
authors.lastname: Altay
authors.forename: Meltem
authors.initials: M
authors.lastname: Refiker Ege
authors.forename: Vedat
authors.initials: V
authors.lastname: Çaldır
authors.forename: Mehmet Birhan
authors.initials: MB
authors.lastname: Yılmaz
authors.forename: Yeşim
authors.initials: Y
authors.lastname: Güray
authors.forename: Ümit
authors.initials: Ü
authors.lastname: Güray
authors.forename: Hatice
authors.initials: H
authors.lastname: Şaşmaz
mesh_terms: D000368:Aged; D060050:Angina, Stable / Q000097:blood* / Q000150:complications / Q000000981:diagnostic imaging; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood* / Q000150:complications / Q000000981:diagnostic imaging; D023921:Coronary Stenosis / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging; D003404:Creatinine / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D008076:Cholesterol, HDL; D002784:Cholesterol; D003404:Creatinine