Katayama Taiga, Hioki Hirofumi, Kyono Hiroyuki, Watanabe Yusuke, Yamamoto Hirosada, Kozuma Ken
Division of Cardiology, Department of Internal Medicine, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan.
Heart Vessels. 2020 Jul;35(7):887-893. doi: 10.1007/s00380-020-01558-4. Epub 2020 Jan 22.
The prognostic value of the geriatric nutritional risk index (GNRI) in patients undergoing percutaneous coronary intervention (PCI) with rotational atherectomy (RA) remains unknown. Therefore, we aimed to clarify whether the GNRI could predict major adverse cardiac events (MACE) in patients undergoing PCI with RA. A total of 206 patients who underwent PCI with RA from January 2009 to December 2017 were retrospectively tracked. The patients were divided into 2 groups based on the GNRI value on admission. MACE comprised all-cause death, target lesion revascularization (TLR), target vessel revascularization (TVR), and myocardial infarction. One year of follow up was completed in 95.6% of patients. During this period, 50 cases of MACE were observed (all-cause death, 32 cases; TLR, 21 cases; and TVR, 2 cases). Patients with a low GNRI (< 98) had a significantly higher incidence of MACE than did patients with a high GNRI (≥ 98) (37.9% vs. 15.5%, log-rank p < 0.05). The GNRI was an independent predictor of MACE (hazard ratio, 0.94; 95% confidence interval [CI], 0.92-0.97). Furthermore, the GNRI had better predictive power than did its components alone (i.e. body mass index and serum albumin level) (net-reclassification improvement, 0.39; 95% CI, 0.07-0.71; p = 0.01; integrated discrimination improvement, 0.02; 95% CI, - 0.01-0.04; p = 0.07). The GNRI on admission is a predictor of MACE after PCI with RA. Further studies are required to determine whether intensive medical therapy could improve clinical events, particularly cardiovascular death and revascularization, in this population.
老年营养风险指数（GNRI）在接受冠状动脉旋磨术（RA）的经皮冠状动脉介入治疗（PCI）患者中的预后价值尚不清楚。因此，我们旨在明确GNRI是否能够预测接受RA的PCI患者的主要不良心脏事件（MACE）。对2009年1月至2017年12月期间接受RA的PCI治疗的206例患者进行了回顾性跟踪。根据入院时的GNRI值将患者分为两组。MACE包括全因死亡、靶病变血运重建（TLR）、靶血管血运重建（TVR）和心肌梗死。95.6%的患者完成了一年的随访。在此期间，观察到50例MACE（全因死亡32例；TLR 21例；TVR 2例）。GNRI低（<98）的患者MACE发生率显著高于GNRI高（≥98）的患者（37.9%对15.5%，对数秩检验p<0.05）。GNRI是MACE的独立预测因子（风险比，0.94；95%置信区间[CI]，0.92-0.97）。此外，GNRI的预测能力优于其单独的组成部分（即体重指数和血清白蛋白水平）（净重新分类改善，0.39；95%CI，0.07-0.71；p=0.01；综合判别改善，0.02；95%CI，-0.01-0.04；p=0.07）。入院时的GNRI是接受RA的PCI术后MACE的预测因子。需要进一步研究以确定强化药物治疗是否能够改善该人群的临床事件，尤其是心血管死亡和血运重建。
