Nakanishi Nobuhiro, Kaikita Koichi, Ishii Masanobu, Kuyama Naoto, Tabata Noriaki, Ito Miwa, Yamanaga Kenshi, Fujisue Koichiro, Hoshiyama Tadashi, Kanazawa Hisanori, Hanatani Shinsuke, Sueta Daisuke, Takashio Seiji, Arima Yuichiro, Araki Satoshi, Usuku Hiroki, Nakamura Taishi, Suzuki Satoru, Yamamoto Eiichiro, Soejima Hirofumi, Matsushita Kenichi, Tsujita Kenichi
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Japan.
Nutr Metab Cardiovasc Dis. 2022 May;32(5):1227-1235. doi: 10.1016/j.numecd.2022.01.016. Epub 2022 Jan 29.
Although antithrombotic treatments are established for coronary artery disease (CAD), they increase the bleeding risk, especially in malnourished patients. The total thrombus-formation analysis system (T-TAS) is useful for the assessment of thrombogenicity in CAD patients. Here, we examined the relationships among malnutrition, thrombogenicity and 1-year bleeding events in patients undergoing percutaneous coronary intervention (PCI).
This was a retrospective analysis of 300 consecutive CAD patients undergoing PCI. Blood samples obtained on the day of PCI were used in the T-TAS to compute the thrombus formation area under the curve. We assigned patients to two groups based on the geriatric nutritional risk index (GNRI): 102 patients to the lower GNRI group (≤98), 198 patients to the higher GNRI group (98<). The primary endpoint was the incidence of 1-year bleeding events defined by Bleeding Academic Research Consortium criteria types 2, 3, or 5. The T-TAS levels were lower in the lower GNRI group than in the higher GNRI group. Kaplan-Meier analysis showed worse 1-year bleeding event-free survival in the lower GNRI group compared with the higher GNRI group. The combined model of the GNRI and the Academic Research Consortium for High Bleeding Risk (ARC-HBR) had good calibration and discrimination for bleeding risk prediction. In addition, having a lower GNRI and ARC-HBR positivity was associated with 1-year bleeding events.
A lower GNRI could reflect low thrombogenicity evaluated by the T-TAS and determine bleeding risk in combination with ARC-HBR positivity.
尽管抗血栓治疗已被确立用于冠状动脉疾病（CAD），但它们会增加出血风险，尤其是在营养不良的患者中。全血栓形成分析系统（T-TAS）有助于评估CAD患者的血栓形成倾向。在此，我们研究了接受经皮冠状动脉介入治疗（PCI）的患者中营养不良、血栓形成倾向与1年出血事件之间的关系。
这是一项对300例连续接受PCI的CAD患者的回顾性分析。PCI当天采集的血样用于T-TAS以计算曲线下血栓形成面积。我们根据老年营养风险指数（GNRI）将患者分为两组：102例患者分为较低GNRI组（≤98），198例患者分为较高GNRI组（>98）。主要终点是根据出血学术研究联盟标准2、3或5定义的1年出血事件的发生率。较低GNRI组的T-TAS水平低于较高GNRI组。Kaplan-Meier分析显示，较低GNRI组的1年无出血事件生存率低于较高GNRI组。GNRI与高出血风险学术研究联盟（ARC-HBR）的联合模型对出血风险预测具有良好的校准和区分能力。此外，较低的GNRI和ARC-HBR阳性与1年出血事件相关。
较低的GNRI可反映通过T-TAS评估的低血栓形成倾向，并结合ARC-HBR阳性来确定出血风险。
