SULM – Schweizerische Union für Labormedizin | Union Suisse de Médecine de Laboratoire | Swiss Union of Laboratory Medicine

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C.H. Saely1 , S. Aczel1 , P. Langer1 , T. Marte1 , H. Drexel1

1Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria

Background: Recently the association between renal function and cardiovascular disease has attracted much interest.
Methods: We enrolled 756 patients undergoing coronary angiography for suspected coronary artery disease (CAD). With respect to serum creatinine we built three groups of patients: patients with low serum creatinine < 1.0 mg/dl (group 1; n = 171), patients with serum creatinine 𕟳.0 mg/dl, but within the normal range, i.e. < 1.2 for women, and < 1.5 for men (group 2; n = 510), and patients with mildly elevated serum creatinine above the normal range, but 𕟫 mg/dl (group 3; n = 64). Patients with serum creatinine >3 mg/dl (n = 11) were excluded from the analyses. Creatinine clearance was estimated with the Cockroft-Gault equation. During a mean follow up period of 2.3 ± 0.4 years the incidence of vascular events was recorded. Results: Patients from both groups 2 and 3 were at a higher risk of significant coronary stenoses 󖾦% than patients from group 1, with adjusted relative OR of 2.06 [1.38-3.07; p < 0.001], and 2.16 [1.13-4.11; p = 0.019], respectively. Concordantly, creatinine clearance proved inversely associated with the presence of significant stenoses (standardized adjusted OR = 0.727 [0.585-0.903; p = 0.004). Prospectively patients from groups 2 and 3 were at an increased risk of vascular events (n = 93), with adjusted OR of 3.29 [1.38-7.84; p = 0.007], and 5.64 [2.11-15.07; p = 0.001], respectively. Creatinine clearance was inversely associated with the risk of vascular events (standardized adjusted OR = 0.54 [0.41-0.73; p < 0.001]).
Conclusions: Among patients undergoing coronary angiography, serum creatinine as well as creatinine clearance are strong independent predictors of angiographic CAD and of vascular events. Even slight elevations of serum creatinine within the normal range are associated with an increased prevalence of angiographic CAD and with an increased incidence of vascular events.

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