Prognostic Value of Estimated Glomerular Filtration Rate in Older Patients With Acute Coronary Syndrome

Background: While the association between estimated glomerular filtration rate (eGFR) and cardiovascular disease has been well established in younger populations, the prognostic significance of this marker in older individuals remains less well defined. Thus, this study aimed to evaluate the predictive value of eGFR in patients aged 80 years or older with acute coronary syndrome (ACS). Methods: We enrolled 551 patients aged ≥80 years hospitalized for ACS, who had the eGFR calculated at admission. The participants were further stratified into three groups by eGFR levels: Low-eGFR group (L-eGFR, eGFR < the 20th percentile), Medium-eGFR group (M-eGFR, the 20th percentile ≤ eGFR < the 80th percentile), and High-eGFR group (H-eGFR, eGFR ≥ the 80th percentile). Major adverse cardiovascular events (MACEs) were recorded during the follow-up period. Results: During a median 63-month follow-up, the L-eGFR group exhibited a higher cumulative incidence of MACEs, while the H-eGFR group showed a relatively improved prognosis compared with the M-eGFR group. A multivariate Cox regression analysis revealed that reduced eGFR levels remained independently predictive for long-term MACEs. Compared with the M-eGFR group, the L-eGFR group showed a higher risk (hazard ratio (HR) 1.542, 95% confidence interval (CI): 1.104–2.155). The H-eGFR group exhibited a protective effect (HR 0.643, 95% CI: 0.438–0.943). Conclusions: Reduced eGFR levels were independent predictors for long-term MACEs in older ACS patients. The H-eGFR group had an improved prognosis, suggesting that further exploration of the underlying mechanism linking renal function and prognosis is warranted.