Prognostic implications of renal dysfunction in patients with stable angina pectoris

Abstract

Objective. Impaired renal function is emerging as an independent risk factor for cardiovascular (CV) disease. We analysed the prognostic implications of estimated renal function in patients with angina pectoris. Design. Post hoc analysis of the Angina Prognosis Study In Stockholm (APSIS). The estimated creatinine clearance (eCrCl) was calculated according to the Cockcroft-Gault formula in 808 patients. Outcomes were compared for subgroups with CrCl ‡90, 60-89 and<60 mL min )1 . Setting. Hospital-based study with patients referred from primary care and hospital. Subjects. A total of 809 patients (248 women) with clinically diagnosed stable angina pectoris. Intervention. Double-blind treatment with metoprolol or verapamil.Results. One hundred and sixty-four patients (91 women) had an eCrCl below 60 mL min )1 . During a median follow-up of 40 months, 38 patients suffered CV death and 31 patients had a nonfatal myocardial infarction (MI). In a univariate analysis a lower eCrCl was related to a higher risk for CV death or MI amongst men (log rank P ¼ 0.036). A multivariate Cox analysis showed an independent prognostic importance of eCrCl for CV death (P ¼ 0.046) and for CV death or MI (P ¼ 0.042) amongst all patients. When analysed as a continuous variable, a 1 mL min )1 decrease in eCrCl was associated with a 1.6% (0.1-3.1) increase in the risk for CV death or MI, and a 2.1% (0-4.1) increase in the risk for CV death alone. Conclusion. Renal dysfunction was found to be common in patients with stable angina pectoris and estimated creatinine clearances carried significant independent prognostic information regarding CV death and nonfatal MI.

Risk prediction in stable angina pectoris

“…Furthermore, in the current study, risk prediction by serum creatinine was superior to estimated creatinine clearance. We have previously shown that estimated creatinine clearance provides risk prediction, particularly among men [5]. However, in the present multivariate analyses, serum creatinine was a simple and useful marker for CV risk in stable angina pectoris.…”

“…ST depression during LTER < 0Á05 < 0Á05 [11] ST depression > 30 min during LTER < 0Á05 [11] Echocardiography LVEDD < 0Á001 [12] LVESD < 0Á001 [12] were considered normal, and by creatinine clearance, calculated according to the Cockroft-Gault formula [5]. Specially trained research nurses performed an interview regarding psychosocial factors based on standardised questionnaires for the evaluation of psychosomatic symptoms, job strain, self-rated Type A behaviour including hostility, sleep disturbances and self-rated overall life satisfaction.…”

“…Laboratory tests included standard blood chemistry [7,9,19], glucose metabolism [4], and haemostatic mechanisms and endothelial function [7]. Renal function was estimated by serum creatinine levels, for which values below 100 lM in women and 110 lM in men Echocardiography LVEDD < 0Á001 [12] LVESD < 0Á001 [12] were considered normal, and by creatinine clearance, calculated according to the Cockroft-Gault formula [5]. Specially trained research nurses performed an interview regarding psychosocial factors based on standardised questionnaires for the evaluation of psychosomatic symptoms, job strain, self-rated Type A behaviour including hostility, sleep disturbances and self-rated overall life satisfaction.…”

Renal Impairment Predicts Long-Term Mortality Risk after Acute Myocardial Infarction

“…Other studies, although limited in follow-up, reported consistent findings in patients with non-ST elevation MI and stable angina. 5,19 Whereas CKD has been found to be a risk factor for increased all-cause mortality up to 10 yr in the general population, 20 -24 to our knowledge, no previous study addressed long-term mortality specifically in patients who were hospitalized with AMI. We further add to the literature an analysis of the relative importance of renal function compared with traditional risk factors.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Despite growing appreciation for the importance of CKD in patients with acute myocardial infarction (AMI), no previous study has investigated longterm mortality risks associated with the entire spectrum of renal function. Furthermore, it is unclear whether the magnitude of mortality risks in patients with impaired function changes over time.…”