Objective To investigate the clinical features and prognosis of coronary artery disease in patients with chronic renal failure.Methods A retrospective study was performed on 142 elderly patients with coronary artery disease diagnosed between June 2006 and December 2007.According to the complication of renal failure or not,the subjects were divided into chronic renal failure group (n=98) and non-chronic renal failure (control) group (n=44).The clinical characteristics,coronary artery lesions and main cardiac adverse events (MCAE) were compared between the two groups.Results (1) Compared with control group,the hypertension incidence was higher (79.6% vs 59.1%,P<0.05),and left ventricular ejection fraction was lower 〔(50.6±9.5)% vs (54.8±6.2)%,P<0.01〕in renal failure group.(2) There were more cases with triple vessel lesions,more cases with calcification,more cases receiving medication,and less cases receiving percutaneous coronary intervention in chronic renal failure group than in control group (69.4% vs 31.8%,P<0.001;57.1% vs 29.5%,P<0.01;70.4% vs 34.1%,P<0.001;24.5% vs 52.3%,P<0.001 respectively).(3)The incidence of acute coronary syndrome and incidence of acute heart failure were higher in renal failure group than in control group(53.1 % vs 27.3%,27.6% vs 11.4% respectively,P<0.05).(4)Logistic analysis showed that bedside systolic blood pressure (β=0.65,P<0.001) and glomerular filtration rate (β=-0.49,P<0.001) were independent risk factors for MCAE in patients with coronary heart disease.Conclusion There are more extensive coronary lesions,more obvious calcification,and lower percentage of revascularization in coronary artery disease patients with renal failure.They also have higher incidence of,but asymptomatic MCAE.Chronic renal failure is an important predictor for the development and prognosis of coronary artery disease.