Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University.
Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province.
Int Heart J. 2023;64(3):417-426. doi: 10.1536/ihj.22-475.
Nutritional risk is closely related to the poor prognosis of hospitalized patients. However, the association of pre-procedural nutritional risk with periprocedural myocardial infarction (PMI) after percutaneous coronary intervention (PCI) remains unclear.A total of 22,267 patients who underwent elective PCI were enrolled in this retrospective cross-sectional study. Nutritional risk was evaluated by three nutritional risk assessment tools, namely, controlling nutritional status (CONUT), prognostic nutritional index (PNI), and geriatric nutritional risk index (GNRI). PMI after PCI was defined as elevation of cardiac troponin I (cTnI) values > 5 × 99th percentile upper reference limit. Linear regression analysis was performed to explore the association of nutritional risk assessment tools with cTnI fold elevation. Log-binomial regression analysis was conducted to determine the association of nutritional risk assessment tools with PMI.The average age of the enrolled patients was 66.4 years old, and 2,647 of them (11.9%) suffered PMI after PCI. Multivariable linear regression analysis determined a linear association between nutritional risk assessment tools and cTnI fold elevation (CONUT: β = 0.220, 95% CI [0.088-0.352], P = 0.001; PNI: β = -0.105, 95% CI [-0.146 to -0.065], P < 0.001; GNRI: β = -0.090, 95% CI [-0.122 to -0.057], P < 0.001). Log-binomial regression analysis showed that nutritional risk assessment tools were strongly associated with PMI after PCI (CONUT [4-12 versus 0-1]: RR = 1.168, 95% CI [1.054-1.295], P = 0.003; PNI [< 44 versus ≥ 52]: RR = 1.168, 95% CI [1.038-1.315], P = 0.010; GNRI [< 98 versus ≥ 108]: RR = 1.128, 95% CI [1.006-1.264], P = 0.039).Pre-procedural nutritional status, assessed by CONUT, PNI, and GNRI, was significantly and strongly associated with PMI in patients undergoing elective PCI.
营养风险与住院患者的不良预后密切相关。然而，经皮冠状动脉介入治疗（PCI）前的营养风险与 PCI 后围手术期心肌梗死（PMI）的关系尚不清楚。这项回顾性横断面研究共纳入 22267 例接受择期 PCI 的患者。采用三种营养风险评估工具评估营养风险，即控制营养状况（CONUT）、预后营养指数（PNI）和老年营养风险指数（GNRI）。PCI 后 PMI 定义为肌钙蛋白 I（cTnI）值升高>5×99 百分位上限。采用线性回归分析探讨营养风险评估工具与 cTnI 倍数升高的关系。采用对数二项式回归分析确定营养风险评估工具与 PMI 的关系。
纳入患者的平均年龄为 66.4 岁，其中 2647 例（11.9%）在 PCI 后发生 PMI。多变量线性回归分析确定营养风险评估工具与 cTnI 倍数升高之间存在线性关系（CONUT：β=0.220，95%CI[0.088-0.352]，P=0.001；PNI：β=-0.105，95%CI[-0.146 至-0.065]，P<0.001；GNRI：β=-0.090，95%CI[-0.122 至-0.057]，P<0.001）。对数二项式回归分析显示，营养风险评估工具与 PCI 后 PMI 密切相关（CONUT[4-12 与 0-1]：RR=1.168，95%CI[1.054-1.295]，P=0.003；PNI [<44 与≥52]：RR=1.168，95%CI[1.038-1.315]，P=0.010；GNRI [<98 与≥108]：RR=1.128，95%CI[1.006-1.264]，P=0.039）。
经皮冠状动脉介入治疗前的营养状况，由 CONUT、PNI 和 GNRI 评估，与择期 PCI 患者的 PMI 显著且密切相关。
