Abstract: Objective To investigate the effect of renal insufficiency on cardiovascular events and all-cause death in elderly patients with coronary heart disease after acute lower respiratory tract infection（ALRTI）. Methods This was a prospective, controlled and observational cohort study. From January 2011 and December 2013, clinical data about elderly patients with coronary heart disease hospitalized for ALRTI in the second medical center of Chinese PLA General Hospital were collected. The patients were divided into two groups（renal insufficiency group and normal renal functional group） based on their value of blood serum creatinine estimated glomerular filtration rate（e GFR） determined by the MDRD equation. The incidence of cardiovascular events and all-cause mortality were analyzed within 90 days of follow-up. Results A total of 514 patients were included in the study, there were 195 patients in the renal insufficiency group and 319 patients in the control group, with mean age of 88±5 years. The incidence of renal insufficiency was 37.9%. Compared with the normal renal function group, the incidence of cardiovascular events and all-cause mortality in the renal insufficiency group were significantly higher（43.1% vs 29.2%, P =0.001; 17.9% vs 10.3%, P=0.014）. The follow-up results showed that the survival rate of elderly coronary heart disease patients with renal insufficiency significantly reduced（log-rank χ²=4.968, P =0.026）. Conclusion Once acute lower respiratory tract infection occurs in elderly patients with coronary heart disease complicated by renal insufficiency, the risk of recent cardiovascular events and all-cause mortality will increase.