Abstract
BackgroundAgeing is a risk factor for both coronary artery disease (CAD) and reduced renal function (RRF), and it is also associated with poor prognosis in patients with CAD or RRF. However, little is known about whether the impact of RRF on clinical outcomes are different in CAD patients at different age groups. This study aimed to investigate whether ageing influences the effect of RRF on long-term risk of death in patients with CAD.MethodsA retrospective analysis was conducted using data from a single-center cohort study. Three thousand and two consecutive patients with CAD confirmed by coronary angiography were enrolled. RRF was defined as an estimated glomerular filtration rate (eGFR) of less than 60 ml/min. The primary endpoint in this study was all-cause mortality.ResultsThe mean follow-up time was 29.1 ± 12.5 months and death events occurred in 275 cases (all-cause mortality: 9.2%). The correlation analysis revealed a negative correlation between eGFR and age (r = − 0.386, P < 0.001). Comparing the younger group (age ≤ 59) with the elderly one (age ≥ 70), the prevalence of RRF increased from 5.9 to 27.5%. Multivariable Cox regression revealed that RRF was independently associated with all-cause mortality in all age groups, and the relative risks in older patients were lower than those in younger ones (age ≤ 59 vs. age 60–69 vs. age ≥ 70: hazard ratio [HR] 2.57, 95% confidence interval [CI] 1.04–6.37 vs. HR 2.00, 95% CI 1.17–3.42 vs. HR 1.46, 95% CI 1.06–2.02). There was a significant trend for HRs for all-cause mortality according to the interaction terms for RRF and age group (RRF*age [≤59] vs. RRF*age [60–69] vs. RRF*age [≥70]: HR 1.00[reference] vs. HR 0.60, 95% CI 0.23–1.54 vs. HR 0.32, 95% CI 0.14–0.75; P for trend = 0.010).ConclusionsRRF may have different impacts on clinical outcomes in CAD patients at different age groups. The association of RRF with the risk of all-cause mortality was attenuated with ageing.
Highlights
Ageing is a risk factor for both coronary artery disease (CAD) and reduced renal function (RRF), and it is associated with poor prognosis in patients with CAD or RRF
This study showed that 1) RRF was more prevalent in the aged CAD patients than in the young ones; 2) RRF might have different impacts on clinical outcomes in CAD patients at different age groups, and the association of RRF with the relative risk of all-cause mortality was attenuated with ageing
The present study showed that the relative risk for death of moderate to severe renal insufficiency was higher in the younger CAD patients than in the older ones, which was consistent with the study conducted in the general population [17]
Summary
Ageing is a risk factor for both coronary artery disease (CAD) and reduced renal function (RRF), and it is associated with poor prognosis in patients with CAD or RRF. Little is known about whether the impact of RRF on clinical outcomes are different in CAD patients at different age groups. CAD patients are a high-risk population for CKD [6], and reduced renal function (RRF) resulting from CKD is associated with adverse outcomes. There is an interaction between CAD and RRF, and ageing is a risk factor for the incidence and poor prognosis of the both. Little is known about whether the effects of RRF on clinical outcomes are different in CAD patients at different age groups
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