Joanna Downer
Johns Hopkins Medicine

By more closely scrutinizing levels of creatinine, a breakdown product of muscle, doctors may be able to prevent future heart attacks in people who present at hospitals with chest pain, a Johns Hopkins study reveals.

For several years, doctors have known that individuals with high levels of creatinine, an indication of kidney failure, are at increased risk of developing coronary artery disease. A wide range of levels considered normal, however, exists. To see if high-normal levels of creatinine could predispose a person to poor outcomes, Johns Hopkins doctors prospectively followed 459 patients with ongoing chest pain who were admitted to the hospital because of a suspected heart attack. They discovered that among patients with high-normal creatinine, 22 percent suffered a subsequent myocardial infarction, revascularization (surgery to restore blood supply) or death by 120 days, in comparison with 13 percent of patients with low-normal levels of the white crystalline compound.

"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, a cardiology fellow at Johns Hopkins who presented the research March 8 during the American College of Cardiology's annual meeting. Working up these individuals more aggressively, he said, could help better identify individuals at risk and save lives.

Henrikson's collaborators were David Bush, Eric Howell and Nisha Chandra-Strobos.

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