Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan.
Clin Res Cardiol. 2017 Nov;106(11):875-883. doi: 10.1007/s00392-017-1132-z. Epub 2017 Jun 20.
Recently, malnutrition has been shown to be related to worse clinical outcomes in patients with heart failure. However, the association between nutritional status and clinical outcomes in patients with coronary artery disease (CAD) remains unclear. We investigated the prognostic value of malnutrition assessed by the Controlling Nutritional Status (CONUT; range 0-12, higher = worse, consisting of serum albumin, cholesterol and lymphocytes) score in patients with CAD.
The CONUT score was measured on admission in a total of 1987 patients with stable CAD who underwent elective percutaneous coronary intervention (PCI) between 2000 and 2011. Patients were divided into two groups according to their CONUT score (0-1 vs. ≥2). The incidence of major adverse cardiac events (MACE), including all-cause death and non-fatal myocardial infarction, was evaluated.
The median CONUT score was 1 (interquartile range 0-2). During the median follow-up of 7.4 years, 342 MACE occurred (17.2%). Kaplan-Meier curves revealed that patients with high CONUT scores had higher rates of MACE (log-rank p < 0.0001). High CONUT scores showed a significant increase in the incidence of MACE compared with low CONUT scores, even after adjusting for confounding factors (hazard ratio: 1.64, 95% confidence interval 1.30-2.07, p < 0.0001). Adding CONUT scores to a baseline model with established risk factors improved the C-index (p = 0.02), net reclassification improvement (p = 0.004) and integrated discrimination improvement (p = 0.0003).
Nutritional status assessed by the CONUT score was significantly associated with long-term clinical outcomes in patients with CAD. Pre-PCI assessment of the CONUT score may provide useful prognostic information.
最近的研究表明，营养不良与心力衰竭患者的临床结局较差有关。然而，冠状动脉疾病（CAD）患者的营养状况与临床结局之间的关系尚不清楚。我们研究了 CAD 患者的控制营养状况（CONUT；范围 0-12，得分越高表示营养状况越差，由血清白蛋白、胆固醇和淋巴细胞组成）评分评估的营养不良与预后的关系。
共纳入 1987 例行择期经皮冠状动脉介入治疗（PCI）的稳定型 CAD 患者，于 2000 年至 2011 年期间入院时测量 CONUT 评分。根据 CONUT 评分（0-1 分与≥2 分）将患者分为两组。评估主要不良心脏事件（MACE）的发生率，包括全因死亡和非致死性心肌梗死。
CONUT 评分的中位数为 1（四分位距 0-2）。在中位随访 7.4 年期间，共发生 342 例 MACE（17.2%）。Kaplan-Meier 曲线显示，CONUT 评分较高的患者 MACE 发生率更高（对数秩检验，p<0.0001）。即使在校正了混杂因素后，CONUT 评分高的患者发生 MACE 的风险也明显高于 CONUT 评分低的患者（风险比：1.64，95%置信区间 1.30-2.07，p<0.0001）。与仅包含基线模型中已确立的危险因素相比，将 CONUT 评分加入基线模型可提高 C 指数（p=0.02）、净重新分类改善（p=0.004）和综合判别改善（p=0.0003）。
CONUT 评分评估的营养状况与 CAD 患者的长期临床结局显著相关。PCI 前评估 CONUT 评分可能提供有用的预后信息。
