Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, 100029, China.
Research Center for Coronary Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
Nutr Metab Cardiovasc Dis. 2020 Sep 24;30(10):1685-1696. doi: 10.1016/j.numecd.2020.05.016. Epub 2020 Jun 2.
It is recognized that malnutrition increases risk of worse prognosis in patients with various diseases. The present study investigated if poor nutritional status predicts adverse outcomes in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) undergoing percutaneous coronary intervention (PCI).
The study enrolled 2299 patients (mean age: 60.01 ± 8.95 years; 71.8% male) with NSTE-ACS who underwent PCI at Beijing Anzhen Hospital from January to December 2015. The entire cohort was divided into training set (n = 1519) and testing set (n = 780) at a ratio of approximate 2 : 1. Nutritional status was assessed by geriatric nutritional risk index (GNRI). The primary endpoint was a composite of adverse events as follows: all-cause death, non-fatal myocardial infarction (MI) and any revascularization. Multivariate Cox analysis showed that GNRI significantly associated with primary endpoint, independent of other risk factors [hazard ratio (HR) 1.159 per 1-point decrease of GNRI, 95% confidence interval (CI) 1.130-1.189, p < 0.001]. The addition of GNRI to a baseline model had an incremental effect on the predictive value for adverse prognosis in training set [AUC: from 0.821 to 0.873, p < 0.001; category-free net reclassification improvement (NRI): 0.313, p < 0.001; integrated discrimination improvement (IDI): 0.108, p < 0.001]. The incremental effect of GNRI was further validated and confirmed in testing set.
Lower GNRI is a significant predictor of adverse prognosis in patients with NSTE-ACS undergoing PCI. Further studies need to be performed to determine whether nutritional interventions have a positive impact on improving clinical prognosis.
人们认识到，营养不良会增加各种疾病患者预后不良的风险。本研究旨在探讨非 ST 段抬高型急性冠状动脉综合征（NSTE-ACS）患者行经皮冠状动脉介入治疗（PCI）后，营养状况不良是否可预测不良结局。
本研究纳入了 2015 年 1 月至 12 月在北京安贞医院行 PCI 的 2299 例 NSTE-ACS 患者（平均年龄：60.01±8.95 岁；71.8%为男性）。整个队列按大约 2:1 的比例分为训练集（n=1519）和测试集（n=780）。营养状况采用老年营养风险指数（GNRI）评估。主要终点为复合不良事件，包括全因死亡、非致死性心肌梗死（MI）和任何血运重建。多变量 Cox 分析显示，GNRI 与主要终点显著相关，独立于其他危险因素[每降低 1 个 GNRI 点，风险比（HR）为 1.159，95%置信区间（CI）为 1.130-1.189，p<0.001]。在训练集中，GNRI 加入基线模型后对不良预后的预测价值具有附加效应[AUC：从 0.821 增加至 0.873，p<0.001；无分类净重新分类改善（NRI）：0.313，p<0.001；综合判别改善（IDI）：0.108，p<0.001]。该附加效应在测试集中进一步得到验证和确认。
较低的 GNRI 是 NSTE-ACS 患者 PCI 后不良预后的重要预测指标。需要进一步研究确定营养干预是否对改善临床预后有积极影响。
