Wada Hideki, Dohi Tomotaka, Miyauchi Katsumi, Doi Shinichiro, Naito Ryo, Konishi Hirokazu, Tsuboi Shuta, Ogita Manabu, Kasai Takatoshi, Hassan Ahmed, Okazaki Shinya, Isoda Kikuo, Suwa Satoru, Daida Hiroyuki
Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Am J Cardiol. 2017 Jun 1;119(11):1740-1745. doi: 10.1016/j.amjcard.2017.02.051. Epub 2017 Mar 16.
Malnutrition has been identified as an important predictor of poor clinical outcomes in patients with heart failure. The aim of this study is to examine the prognostic impact of nutritional status in patients with coronary artery disease (CAD) who underwent percutaneous coronary intervention (PCI). The impact of nutrition, assessed using the geriatric nutritional risk index (GNRI) calculated by serum albumin and body mass index, was evaluated in 2,853 patients with CAD who underwent their first PCI between 2000 and 2011. Patients were assigned to tertiles based on their GNRI levels. The incidences of all-cause death and cardiac death were assessed. The median GNRI values were 101 (interquartile range 95 to 106). Lower GNRI levels were associated with older age and higher prevalence of acute coronary syndrome and chronic kidney disease. During the median follow-up period of 7.4 years, Kaplan-Meier curves showed ongoing divergence in rates of mortality among tertiles (GNRI <98: 35.1%; 98 to 104: 20.6%; ≥104: 12.1%; log-rank p <0.0001). Stratification analysis by age also showed that the lowest GNRI tertile was associated with mortality in both patients <65 years and those ≥65 years. After adjusting for established cardiovascular risk factors, lower GNRI was an independent predictor of all-cause death (hazard ratio 1.55 per 10 decrease, 95% confidence interval 1.30 to 1.84, p <0.0001) and cardiac death (hazard ratio 1.44, 95% confidence interval 1.08 to 1.90, p = 0.01). In conclusion, nutritional status was associated with long-term clinical outcomes in CAD patients after PCI. Evaluation of GNRI carries important prognostic information and may guide the therapeutic approach to such patients.
营养不良已被确认为心力衰竭患者临床预后不良的重要预测因素。本研究旨在探讨营养状况对接受经皮冠状动脉介入治疗（PCI）的冠心病（CAD）患者的预后影响。使用基于血清白蛋白和体重指数计算的老年营养风险指数（GNRI）评估营养状况，对2000年至2011年间首次接受PCI的2853例CAD患者进行了评估。根据GNRI水平将患者分为三个三分位数组。评估全因死亡和心源性死亡的发生率。GNRI的中位数为101（四分位间距95至106）。较低的GNRI水平与老年、急性冠状动脉综合征和慢性肾脏病的较高患病率相关。在中位随访期7.4年期间，Kaplan-Meier曲线显示三分位数组之间的死亡率持续存在差异（GNRI<98：35.1%；98至104：20.6%；≥104：12.1%；对数秩检验p<0.0001）。按年龄分层分析还显示，最低的GNRI三分位数组与65岁以下和65岁及以上患者的死亡率均相关。在调整了既定的心血管危险因素后，较低的GNRI是全因死亡（每降低10分风险比为1.55，95%置信区间1.30至1.84，p<0.0001）和心源性死亡（风险比1.44，95%置信区间1.08至1.90，p=0.01）的独立预测因素。总之，营养状况与PCI术后CAD患者的长期临床预后相关。GNRI评估具有重要的预后信息，可能指导对此类患者的治疗方法。
