Among patients with chest pain admitted for possible myocardial infarction, people with high-normal creatinine levels have almost double the risk of people with low levels for subsequent myocardial infarction, need for revascularization procedure, or death, according to a presentation at the annual meeting of the American College of Cardiology.

Previous research had suggested that individuals with high levels of creatinine, an indication of kidney failure, are at increased risk for development of coronary artery disease. However, interpretation of findings was complicated by variability in the range of levels considered normal.

In the current study, physicians at Johns Hopkins Medical Institutions prospectively followed 459 patients with ongoing chest pain who were admitted to the hospital for possible myocardial infarction. They discovered that among patients with high-normal creatinine levels, 22 percent suffered a subsequent myocardial infarction, needed a revascularization procedure, or died in the next 120 days, compared with 13 percent of patients with low-normal creatinine levels.

"In evaluating patients with chest pain, if there is even a mild elevation of creatinine in the high-normal range, doctors should think twice about how they triage those patients," said Charles Henrikson, M.D., M.P.H., the study presenter. He points out that a more aggressive work-up of these people could better identify patients at high risk for poor outcome and allow earlier use of targeted interventions.