Prognostic significance of serum creatinine in patients with acute coronary syndromes for prediction of inhospital mortality

Context

Patients with renal dysfunction are at an increased risk for cardiovascular disease.

Objective

To evaluate the prognostic significance of serum creatinine for inhospital mortality in patients with acute coronary syndromes.

Design

An observational study.

Patients and methods

Included were consecutive patients with acute coronary syndromes admitted alive to the coronary care unit from February 2004 to January 2005. The patients were initially classified into three groups on the basis of serum creatinine concentration measured on admittance. Normal renal function and mild and severe renal dysfunction were defined as serum creatinine concentrations of <1.2 mg/dl, ≥ 1.2 but <2.0 mg/dl, and ≥ 2.0 mg/dl, respectively. Patients receiving regular hemodialysis were excluded from the study. Univariate and multivariate relative risks (RRs) were calculated for three renal risk quartiles using the serum creatinine concentration on presentation.

Results

This study included 227 patients. The mean age was greater in the severe renal dysfunction group (P = 0.031). Of the analysed variables – age, sex, diabetes, hypertension, dyslipidemia, previous myocardial infarction, previous coronary angioplasty and coronary artery bypass graft – only the creatinine level was an independent predictor of greater inhospital mortality. The inhospital mortalities of mild and severe renal dysfunction patients were greater (7.9% and 31.6%, respectively) than that of patients without renal dysfunction (2.8%), P = 0.000, with an increased risk of 10 times.

Conclusion

In this study, we showed that the creatinine level at admission is an independent predictor of inhospital mortality in patients with acute coronary syndromes.