The Relationship Between Coronary Atherosclerosis, Heart Function And Glomerular Filtration Rate In Elderly Patients With Coronary Heart Disease

OBJECTIVE:In recent years, The Relationship between renal insufficiency and coronary heart disease has attracted attention. Many studies have shown that there is a association of renal insufficiency with cardiovascular events and poor prognosis; kidney structure, function changes in the the elderly people, and the glomerular filtration rate is a decreasing trend with age;research has shown that glomerular filtration rate (GFR) of decline with the degree of coronary lesions. But, with the modified abbreviated MDRD equation for our country to estimate GFR and for the derly patients with coronary artery disease on the relationship between renal function and degree of coronary lesions and cardiac function is currently no related reports for China. The aim of this study is to investigate the relationship between coronary atherosclerosis, heart function and GFR in elderly patients with Coronary Heart Disease,by estimation of glomerular filtration rate in elderly patients before surgery,to evaluate the severity and prognosis of coronary artery disease. and try to prevent the occurrence of contrast nephropathy. METHODS:240patients were selected who had undergone coronary angiography and aged≥60years(males115and women125). Basis on coronary angiography, the mean coronary pathological changes limits score were assessed by the number of stenotic vessels as follows:1=no vessel disease:2-one-vessel disease;3=two-vessel disease;4=three-vessel or more vessel disease. The severity of atherosclerotic changes was also assessed by grading the stenotic lesions as follows:0=luminal reduction<25%;1=luminal reduction of25%to49%;2=luminal reduction of50%to74%;3=luminal reduction of75%to99%; and4=total occlusion. A coronary narrow severity score was obtained by adding to each branch of the coronary artery. Standard of K/DOQI by was chosen as the criterion of chronic renal insufficiency, then divided the patients into three groups:normal renal function group, mild renal insufficiency group and moderate to severe renal insufficiency groups. Baseline clinical characteristics, cardiac function and coronary atherosclerotic burden were compared among the3groups.RESULTS:the age,the percentage of hypertension and uric acid in mild renal insufficiency group and moderate to severe renal insufficiency group were higher than normal renal function group(P<0.05), and that prompt the increase with age, the glomerular filtration rate declined. Compared with normal renal function group, the group of patients with moderate to severe loss high propor-tion of males (P=0.002), but with normal renal function and reduce mild, mild to reduce the group with moderate to severe to reduce the group was no significant difference.The mean coronary pathological changes limits score and mean coronary narrow severity score in the moderate to severe renal insufficiency group greater than the normal renal function group. In Spearman correlation analyse, eGFR was negative correlated with coronary pathological changes Limits score(r=-0.149,P=0.021) and coronary narrow severity score(r=-0.166, P=0.01). By the multivariate Logistic regression analysis,the results showed that age, sex, hypertension, diabetes, triglycerides are an independent risk factor of coronary lesions, but the regression coefficient between eGFR and the severity of coronary lesions was0.014, the difference was not statisti-cally significant (P=0.167), and show that but the lower in eGFR is not an independent risk factor of the severity of coronary lesions.Left atrial diameter, left ventricular ejection fraction was no significant difference among the three groups (P>0.05)CONCLUSION:In the elderly patients, there is a relationship between eGFR and the severity of coronary lesions, but the lower in eGFR is not an independent risk factor of the severity of coronary lesions.By estimation of glomerular filtration rate in elderly patients before surgery, to evaluate the severity and prognosis of coronary artery disease.