Prognostic implications of renal dysfunction in patients with stable angina pectoris

J Intern Med. 2006 Dec;260(6):537-44. doi: 10.1111/j.1365-2796.2006.01728.x.


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 > or =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 = 0.036). A multivariate Cox analysis showed an independent prognostic importance of eCrCl for CV death (P = 0.046) and for CV death or MI (P = 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.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use
  • Aged
  • Angina Pectoris / complications*
  • Angina Pectoris / drug therapy
  • Angina Pectoris / physiopathology
  • Calcium Channel Blockers / therapeutic use
  • Cardiovascular Diseases / mortality
  • Creatinine / metabolism
  • Double-Blind Method
  • Female
  • Humans
  • Kidney / physiopathology
  • Kidney Diseases / complications*
  • Kidney Diseases / physiopathology
  • Male
  • Metabolic Clearance Rate
  • Metoprolol / therapeutic use
  • Middle Aged
  • Myocardial Infarction / complications
  • Myocardial Infarction / physiopathology
  • Prognosis
  • Prospective Studies
  • Treatment Outcome
  • Verapamil / therapeutic use


  • Adrenergic beta-Antagonists
  • Calcium Channel Blockers
  • Creatinine
  • Verapamil
  • Metoprolol