Cheng Lele, Rong Jie, Zhuo Xiaozhen, Gao Ke, Meng Zixuan, Wen Xing, Li Shanshan, Fan Pengcheng, Hao Xiang, Jian Zhijie, Wu Yue, Li Bolin
Department of Cardiovascular Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China; Key Laboratory of Molecular Cardiology, Shaanxi Province, Xi'an, Shaanxi, China; Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, Shaanxi, China.
Affiliated Hospital, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China.
Clin Nutr. 2021 Jun;40(6):4171-4179. doi: 10.1016/j.clnu.2021.01.042. Epub 2021 Feb 5.
Malnutrition is associated with poor prognosis in a wide range of chronic illnesses, however, the impact of malnutrition on long-term outcomes of patients at advanced stages of atherosclerosis, coronary chronic artery occlusion (CTO), is not known.
This study aims to investigate the relationship between malnutrition and adverse cardiovascular events in patients with CTO after percutaneous coronary intervention (PCI).
Baseline malnutrition risk was determined in 669 patients with CTO after PCI in this study. All patients were divided into 3 groups according to 3 categories of the geriatric nutritional risk index (GNRI): moderate to severe, GNRI of <92 (n = 70); low, GNRI of 92-98 (n = 197); and absence of risk, GNRI of ≥98 (n = 402). The primary endpoint was all-cause mortality and the secondary endpoint was major adverse cardiovascular events (MACE).
Average age in this study was 65.32 ± 9.97 years old. More than one-third of patients were at risk of malnutrition (moderate to severe: 10.5%; low: 29.4%; and absence of risk: 60.1%). Over a median follow-up of 33 months, compared to those with absent risk for malnutrition, moderate to severe risk was associated with significantly increased risk for the all-cause death, cardiovascular death and MACE (hazard ratio [HR]: 2.90, 95% confidence interval [CI]: 1.43 to 5.87, P for trend = 0.002; HR: 3.72, 95% CI: 1.42 to 9.77, P for trend = 0.010; HR: 1.76, 95% CI: 1.02 to 3.03, P for trend = 0.040; respectively) after adjustment for baseline variables. Moreover, addition of the GNRI score significantly raised the predictive value for the all-cause death (0.383, p = 0.004 and 0.022, p = 0.011, NRI and IDI respectively), cardiovascular death (0.488, p < 0.001 and 0.013, p = 0.014, NRI and IDI respectively) and MACE (0.368, p = 0.004 and 0.014, p = 0.008, NRI and IDI respectively) as compared to traditional factors.
Malnutrition assessed by the GNRI score on admission was an independent predictor for adverse cardiovascular events in CTO patients after PCI. Addition of the GNRI score to the existing risk prediction model significantly increased the predictive ability for cardiovascular events in CTO patients after PCI.
营养不良与多种慢性疾病的不良预后相关，然而，营养不良对动脉粥样硬化晚期、冠状动脉慢性完全闭塞（CTO）患者长期预后的影响尚不清楚。
本研究旨在探讨经皮冠状动脉介入治疗（PCI）后CTO患者营养不良与不良心血管事件之间的关系。
本研究对669例PCI术后CTO患者的基线营养不良风险进行了评估。根据老年营养风险指数（GNRI）的3个类别，将所有患者分为3组：中度至重度，GNRI<92（n = 70）；低风险，GNRI为92-98（n = 197）；无风险，GNRI≥98（n = 402）。主要终点为全因死亡率，次要终点为主要不良心血管事件（MACE）。
本研究患者的平均年龄为65.32±9.97岁。超过三分之一的患者存在营养不良风险（中度至重度：10.5%；低风险：29.4%；无风险：60.1%）。在中位随访33个月期间，与无营养不良风险的患者相比，中度至重度风险与全因死亡、心血管死亡和MACE风险显著增加相关（风险比[HR]：2.90，95%置信区间[CI]：1.43至5.87，趋势P = 0.002；HR：3.72，95%CI：1.42至9.77，趋势P = 0.010；HR：1.76，95%CI：1.02至3.03，趋势P = 0.040；分别），在对基线变量进行调整后。此外，与传统因素相比，加入GNRI评分显著提高了全因死亡（分别为0.383，p = 0.004和0.022，p = 0.011，NRI和IDI）、心血管死亡（分别为0.488，p < 0.001和0.013，p = 0.014，NRI和IDI）和MACE（分别为0.368，p = 0.004和0.014，p = 0.008，NRI和IDI）的预测价值。
入院时通过GNRI评分评估的营养不良是PCI术后CTO患者不良心血管事件的独立预测因素。将GNRI评分加入现有的风险预测模型可显著提高PCI术后CTO患者心血管事件的预测能力。
