Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China.
BMC Public Health. 2019 Feb 18;19(1):205. doi: 10.1186/s12889-019-6498-6.
Ageing 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.
A 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.
The 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 (RRFage [≤59] vs. RRFage [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).
RRF 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.
年龄是冠状动脉疾病（CAD）和肾功能降低（RRF）的一个风险因素，并且与 CAD 或 RRF 患者的预后不良相关。然而，对于 RRF 对 CAD 不同年龄组患者的临床结局的影响是否不同，目前知之甚少。本研究旨在探讨 RRF 是否会影响 CAD 患者的长期死亡风险。
对一项单中心队列研究的数据进行回顾性分析。纳入了 3200 例经冠状动脉造影证实的 CAD 患者。RRF 定义为估算肾小球滤过率（eGFR）<60ml/min。本研究的主要终点为全因死亡率。
平均随访时间为 29.1±12.5 个月，275 例患者发生死亡事件（全因死亡率：9.2%）。相关性分析显示，eGFR 与年龄呈负相关（r=-0.386，P<0.001）。与年轻组（年龄≤59 岁）相比，老年组（年龄≥70 岁）的 RRF 患病率从 5.9%增加到 27.5%。多变量 Cox 回归显示，RRF 在所有年龄组中均与全因死亡率独立相关，老年患者的相对风险低于年轻患者（年龄≤59 岁与年龄 60-69 岁相比：危险比[HR]2.57，95%置信区间[CI]1.04-6.37 与 HR 2.00，95%CI 1.17-3.42 与 HR 1.46，95%CI 1.06-2.02）。根据 RRF 和年龄组的交互项，全因死亡率的 HR 存在显著趋势（RRF年龄[≤59]与 RRF年龄[60-69]与 RRF*年龄[≥70]：HR 1.00[参考]与 HR 0.60，95%CI 0.23-1.54 与 HR 0.32，95%CI 0.14-0.75；P 趋势=0.010）。
RRF 可能对不同年龄组 CAD 患者的临床结局产生不同的影响。RRF 与全因死亡率风险的相关性随年龄增长而减弱。
