| Section 1:The Association Between Estimated Glomerular Filtration Rate and Prognosis in Advanced-Age Patients with Acute Coronary SyndromeObjectiveEstimated glomerular filtration rate(eGFR)is commonly used to evaluate renal function and closely related to cardiovascular diseases.This study aimed to investigate the association between eGFR and the prognosis in the advanced-age patients with acute coronary syndrome(ACS).MethodsWe enrolled 551 patients aged 80 and above hospitalized in Fuwai Hospital from January 2011 to February 2016 who were diagnosed as ACS.The baseline eGFR at admission was calculated.Major adverse cardiovascular events(MACE)during the long-term follow-up were recorded.MACE were defined as non-fatal myocardial infarction,unplanned target vessel revascularization,readmission for heart failure,non-fatal stroke or transient ischemic attack(TIA)and all-cause death.Kaplan Meier survival curve and Cox regression analysis were applied to explore the impact of eGFR on the long-term prognosis in the elderly ACS patients.ResultsThe median eGFR level was 88.88mL/min per 1.73m2.We divided the patients into three groups:low eGFR group(eGFR<the 20th quantile,n=106),control group(the 20th quantile≤eGFR<the 80th quantile,n=334)and high eGFR group(eGFR≥the 80th quantile,n=111).The median follow-up time was 59 months.The Kaplan Meier survival curve showed that compared to control group,low eGFR group had a higher cumulative incidence of MACE during long-term follow-up while high eGFR group had a relatively better prognosis(P<0.01).Multivariate Cox regression analysis demonstrated that eGFR level was independently associated with the risk of long-term MACE(P<0.05).Compared with control group,low eGFR was an independent risk factor for long-term MACE in elderly ACS patients while high eGFR showed a protective effect(P<0.05).ConclusionDecreased eGFR was independently associated with an increased long-term MACE risk in elderly ACS patients.Compared with control group,low eGFR(eGFR<the 20th quantile)was an independent risk factor while high eGFR(eGFR≥the 80th quantile)reduced the risk of long-term MACE in advanced-age patients with ACS.Section 2:The Impact of Uric Acid on the Prognosis in Advanced-Age Patients with Acute Coronary SyndromeObjectiveUric acid(UA)has important value in cardiovascular diseases.This study aimed to explore the impact of uric acid on the long-term prognosis in the advanced-age patients with acute coronary syndrome(ACS).MethodsWe included 526 patients aged 80 and above who were diagnosed as ACS.The UA levels were detected at admission.Patients were divided into four groups according to the quartile of the baseline UA levels:Group 1(UA≤278.95μmol/L,n=132),Group 2(278.95μmol/L<UA≤344.09μmol/L,n=131),Group 3(344.09μmol/L<UA≤413.06μmol/L,n=131),Group 4(UA>413.06μmol/L,n=132).Major adverse cardiovascular events(MACE)during the long-term follow-up were recorded.MACE were defined as non-fatal myocardial infarction,unplanned target vessel revascularization,readmission for heart failure,non-fatal stroke or transient ischemic attack(TIA)and all-cause death.Kaplan Meier survival curve and Cox regression analysis were used to investigate the association between UA and the occurrence of MACE on the long-term follow-up.ROC was plotted to evaluate the predictive value of UA on the prognosis of advanced-age patients with ACS.The propensity score matching(PSM)method was applied to balance confounding factors.ResultsThe median of UA was 344.83μmol/L,while the median of follow-up time was 62 months.Kaplan Meier curve showed a higher cumulative incidence of MACE during long-term follow-up in Group 4(Log Rank P<0.05).Cox regression analysis demonstrated an independent correlation between UA levels and the increased risk of MACE during long-term follow-up(HR 1.002,95%CI 1.000-1.003,P=0.029).ROC showed that the optimal UA value for predicting long-term MACE is 324.25μmol/L.Through PSM matching,the MACE free survival rate were lower in hyperuricemia group(UA>420.00μmol/L)and high UA level group(UA>324.25μmol/L)than that of control group.Both hyperuricemia and high UA level were independent risk factors for long-term MACE in advanced-age ACS patients with HR 1.602(95%CI 1.101-2.332,P=0.014)and HR 1.437(95%CI 1.010-2.044,P=0.044)respectively.ConclusionElevated UA was an independent risk factor of MACE on the long-term prognosis in the advanced-age patients with ACS.The best predictive value of UA for the poor prognosis was significantly lower than the traditional definition of hyperuricemia. |
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