SERUM CREATININE AS AN INDEPENDENT PREDICTOR OF CORONARY HEART-DISEASE MORTALITY IN NORMOTENSIVE SURVIVORS OF MYOCARDIAL-INFARCTION

Background. Serum creatinine has been reported in previous studies to bc a prognostic indicator for overall mortality, in particular in a hy pertensive population. Methods. The Program on the Surgical Control of the Hyperlipidemias (POSCH) was a randomized, controlled clinical tri al. All patients had survived a single myocardial infarction, were nor motensive, were not obese, were not having heart failure, and were fre e of diabetes mellitus and renal disease at entry into the study. POSC H had followed its control group patients (N = 417) for a minimum of 7 .0 years. In this group, a prospective post hoc analysis of the relati onship of baseline serum creatinine with subsequent overall and athero sclerotic coronary heart disease mortality was performed. Results. The baseline serum creatinine values in the control group patients ranged from 0.7 to 1.9 mg/dL (60 to 170 mumol/L), and were found to be indep endent predictors (P < .01) of both overall mortality and atherosclero tic coronary heart disease mortality. Each 0.1 mg/dL (9 mumol/L) incre ment in the baseline serum creatinine increased the relative risk for subsequent overall mortality by 36% and the relative risk for subseque nt atherosclerotic coronary heart disease mortality by 47%. Conclusion s. These results demonstrate that a serum creatinine value, obtained i n normotensive, nonobese, normoglycemic survivors of a myocardial infa rction without preexistent renal disease or heart failure, provides in dependent prognostic information regarding subsequent overall and athe rosclerotic coronary heart disease mortality.