Serum Creatinine Concentration and the Risk of Stroke, Myocardial Infarction, and Vascular Death in Patients with Symptomatic Carotid Stenosis.
Background: High serum creatinine (SCr) is a predictor of mortality in patients with hypertension, myocardial infarction (MI), and stroke. In men it is associated with stroke. Objective: Examine the relationship between SCr and the risk of stroke, MI, and vascular death (VD) in patients with symptomatic internal carotid artery (ICA) stenosis. Methods: Data from 1977 male NASCET patients with baseline SCr measurements were analyzed. Results: Increased levels of SCr were associated with older age and a higher prevalence of hypertension, history of MI or angina, and intermittent claudication. No association was found between the level of SCr and a history of diabetes or hyperlipidemia or with the type and location of prior cerebrovascular ischemic events. The Kaplan-Meier risk for the outcomes of stroke at 5 years, MI at 5 years, and the combined outcome of stroke, MI, or VD at 5 years increased with increasing levels of SCr (all at a p< 0.001, table). This increased risk was unconfounded and remained statistically significant after adjusting for all baseline characteristics using Cox proportional hazards regression model. The causes of stroke were similar in all SCr level groups (70% large artery, 22% lacunar, 8% cardioembolic). The risk of death from any cause at 5 years increased with increased SCr levels, cardiac disorders were the predominant cause of death. Conclusion: A mild to moderate elevation of serum creatinine level is an independent risk factor for stroke, MI, and VD in male patients with recent ischemic symptoms attributable to carotid artery stenosis.