Nakamura Tomohiro, Haraguchi Yumiko, Matsumoto Mitsunari, Ishida Takeshi, Momomura Shin-Ichi
Department of Medicine, Saitama Citizens Medical Center, 299-1 Shimane, Nishi-ku, Saitama, Saitama, 331-0054, Japan.
Heart Vessels. 2022 Mar;37(3):385-391. doi: 10.1007/s00380-021-01922-y. Epub 2021 Aug 17.
We aimed to investigate the prevalence and the prognostic impact of malnutrition using the geriatric nutritional risk index (GNRI) in elderly patients with acute myocardial infarction (AMI). We investigated 130 consecutive patients aged ≥ 75 years who were discharged following successful primary coronary intervention between March 2009 and December 2016. The mean age of the patients was 81.5 ± 5.0 years, and 55.4% of them were male. At discharge, the patients' nutritional statuses were evaluated using the GNRI, which were calculated as follows: 14.89 × serum albumin (g/dL) + 41.7 × body mass index/22. The patients were divided into two groups, a low GNRI group (GNRI < 92) with nutrition-related risk and a high GNRI group (GNRI ≥ 92) without nutrition-related risk. The mean GNRI score of all patients was 95.2 ± 11.0, and 46 patients (35.4%) had a low GNRI score. During the mean follow-up of 1030 ± 850 days, the all-cause mortality was significantly higher in the low GNRI group than in the high GNRI group (32.6% vs. 13.1%, p < 0.001), while the event rates of AMI recurrence and hospitalization due to heart failure did not differ significantly between the two groups. Multivariate Cox proportional analysis revealed that low GNRI was a modest but independent predictor of mortality (hazard ratio, 0.94; 95% confidence interval 0.90-0.98; p = 0.01). Among elderly patients with AMI, malnutrition assessed using the GNRI was often encountered and was an independent predictor of long-term mortality.
我们旨在利用老年营养风险指数（GNRI）研究老年急性心肌梗死（AMI）患者中营养不良的患病率及其预后影响。我们调查了2009年3月至2016年12月期间130例年龄≥75岁且成功接受直接冠状动脉介入治疗后出院的连续患者。患者的平均年龄为81.5±5.0岁，其中55.4%为男性。出院时，使用GNRI评估患者的营养状况，计算方法如下：14.89×血清白蛋白（g/dL）+41.7×体重指数/22。患者被分为两组，即存在营养相关风险的低GNRI组（GNRI<92）和无营养相关风险的高GNRI组（GNRI≥92）。所有患者的平均GNRI评分为95.2±11.0，46例患者（35.4%）的GNRI评分较低。在平均1030±850天的随访期间，低GNRI组的全因死亡率显著高于高GNRI组（32.6%对13.1%，p<0.001），而两组之间AMI复发和因心力衰竭住院的发生率无显著差异。多变量Cox比例分析显示，低GNRI是死亡率的一个适度但独立的预测因素（风险比，0.94；95%置信区间0.90-0.98；p=0.01）。在老年AMI患者中，使用GNRI评估的营养不良情况较为常见，且是长期死亡率的独立预测因素。
