Abstract: Ojbective: To determine whether estimated glomerular filtration rate（eGFR） at admission is an independent predictor of adverse outcomes in elderly patients with acute coronary syndromes（ACS）.Methods: Records of 372 elderly patients hospitalized with ACS were examined.Clinical characteristics,medication and adverse outcomes were compared for groups with eGFR of ≥60ml·min^-1·（1.73m²）^-1（normal/minimally impaired renal function）,30-59 ml·min^-1·（1.73m²）^-1（moderate renal dysfunction） and ＜30ml·min^-1·（1.73m²）^-1（severe renal dysfunction）.Results: Patients with moderate or severe renal dysfunction were older,more likely to be women,presented with more comorbidities and more likely to develop cardiac events than those with normal or minimally impaired renal function.After adjustment for other confounding factors,moderate and severe renal insufficiency were associated with a higher odds of cardiac death（odds ratio: 2.9695%CI: 2.23-3.65,P=0.017 and 8.1495%CI: 7.04-8.98,P=0.009,respectively）.Conclusion: Moderate to severe renal insufficiency is associated with higher risks for adverse outcomes in elderly patients with a broad range of ACS.More aggressive treatment should be applied to optimize outcomes in this special population.