Wada Hideki, Dohi Tomotaka, Miyauchi Katsumi, Endo Hirohisa, Tsuboi Shuta, Ogita Manabu, Kasai Takatoshi, Okazaki Shinya, Isoda Kikuo, Suwa Satoru, Daida Hiroyuki
Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan.
Heart Vessels. 2018 Dec;33(12):1445-1452. doi: 10.1007/s00380-018-1201-x. Epub 2018 Jun 8.
Previous studies have reported the prognostic value of objective nutritional indices such as the Controlling Nutritional Status (CONUT) score, Geriatric Nutritional Risk Index (GNRI) and Prognostic Nutritional Index (PNI). However, the effects of these indices in patients with coronary artery disease (CAD) who have undergone percutaneous coronary intervention (PCI) remain unclear. Furthermore, there are insufficient data to combine these indices. A total of 1984 patients who underwent elective PCI were enrolled. The Combined Objective Nutritional Score was determined by assigning 1 point each for high CONUT score (3-12), low GNRI (< 98) or low PNI (< 45). Patients were grouped into normal nutritional status (0 points), mild-to-moderate malnutrition (1-2 points) and severe malnutrition (3 points). Incidences of all-cause death and cardiac death were evaluated. Among the 1984 patients, 514 (25.9%) and 244 (12.3%) had mild-to-moderate and severe malnutrition, respectively. During follow-up (median 7.4 years), 293 all-cause deaths were identified, including 92 cardiac deaths. Kaplan-Meier curves showed ongoing divergence in rates of death among nutritional statuses determined by the novel score (log rank test, p < 0.0001). Multivariate Cox hazard analysis showed that patients with a Combined Objective Nutritional Score of 3 showed 2.91-fold (95% confidence interval (CI) 2.10-4.00; p < 0.0001) and 2.16-fold (95% CI 1.15-3.92; p = 0.02) increases in risk of mortality and cardiac mortality compared with patients with a Combined Objective Nutritional Score of 0. In conclusion, malnutrition as evaluated by the Combined Objective Nutritional Score was significantly associated with worse long-term cardiovascular outcomes among CAD patients who underwent PCI.
既往研究报道了客观营养指标的预后价值，如控制营养状况（CONUT）评分、老年营养风险指数（GNRI）和预后营养指数（PNI）。然而，这些指标在接受经皮冠状动脉介入治疗（PCI）的冠心病（CAD）患者中的作用仍不明确。此外，尚无足够数据将这些指标结合起来。共纳入1984例接受择期PCI的患者。综合客观营养评分通过对高CONUT评分（3 - 12）、低GNRI（<98）或低PNI（<45）各赋1分来确定。患者被分为营养状况正常（0分）、轻至中度营养不良（1 - 2分）和重度营养不良（3分）。评估全因死亡和心源性死亡的发生率。在1984例患者中，分别有514例（25.9%）和244例（12.3%）存在轻至中度和重度营养不良。在随访期间（中位时间7.4年），共确定293例全因死亡，其中包括92例心源性死亡。Kaplan-Meier曲线显示，根据新评分确定的营养状况之间的死亡率持续存在差异（对数秩检验，p<0.0001）。多因素Cox风险分析显示，综合客观营养评分为3分的患者与评分为0分的患者相比，死亡风险和心源性死亡风险分别增加2.91倍（95%置信区间（CI）2.10 - 4.00；p<0.0001）和2.16倍（95%CI 1.15 - 3.92；p = 0.02）。总之，综合客观营养评分评估的营养不良与接受PCI的CAD患者较差的长期心血管结局显著相关。
