Miyagawa Masatsugu, Murata Nobuhiro, Arai Riku, Kojima Keisuke, Matsumoto Michiaki, Matsumoto Naoya, Morikawa Tomoyuki, Atsumi Wataru, Tachibana Eizo, Haruta Hironori, Kogo Takaaki, Ebuchi Yasunari, Nomoto Kazumiki, Arai Masaru, Arima Ken, Mineki Takashi, Koyama Yutaka, Oiwa Koji, Okumura Yasuo
Division of Cardiology, Department of Internal Medicine, Nihon University School of Medicine Itabashi Hospital, Tokyo, Japan; Division of Cardiology, Kawaguchi Municipal Medical Center, Saitama, Japan.
Division of Cardiology, Department of Internal Medicine, Nihon University School of Medicine Itabashi Hospital, Tokyo, Japan.
J Cardiol. 2025 Jun 14. doi: 10.1016/j.jjcc.2025.06.006.
Although clinical frailty and nutritional status are associated with adverse events in patients after percutaneous coronary intervention (PCI), those two factors are closely interrelated. This study evaluated the prognostic utility of the Geriatric Nutritional Risk Index (GNRI), a nutritional risk assessment tool, in stratifying outcomes in patients with and without frailty.
We used data from a prospective multicenter registry (SAKURA PCI2 Antithrombotic Registry) from June 2020 until September 2022. This study included 973 patients who underwent PCI [age: 72 (61, 79) years] and had available data. The patients were stratified into four groups based on the Clinical Frailty Scale (CFS) scores (CFS ≥4 defined as vulnerable frailty) and GNRI values (GNRI <92 defined as a high nutritional risk).
Of the total patients, 67 (6.9 %) had vulnerable frailty and GNRI <92, 115 (11.8 %) vulnerable frailty and GNRI ≥92, 98 (10.1 %) non-frailty and GNRI <92, and 693 (71.2 %) non-frailty and GNRI ≥92. During a median follow-up of 737 (565-956) days, a Kaplan-Meier curve revealed that patients with a GNRI <92 had higher rates of composite adverse events, including all-cause death, non-fatal myocardial infarctions, stent thromboses, hospitalizations for heart failure, Bleeding Academic Research Consortium 3 or 5 bleeding events, strokes, and venous thromboembolisms, regardless of the frailty status (log-rank, p < 0.05 for both). After adjusting for potential confounding factors, the vulnerable frailty group with a GNRI <92 had the highest composite adverse event rates, with a hazard ratio of 2.51 (95 % confidence interval 1.59-3.95, p < 0.001) compared to the non-frailty group with a GNRI ≥92.
Both frailty and malnutrition were significantly linked to adverse outcomes in post-PCI patients, with malnutrition exerting an influence regardless of the frailty status. The GNRI, in particular, served as a valuable prognostic tool, enhancing the risk stratification among frail patients following PCI.
尽管临床衰弱和营养状况与经皮冠状动脉介入治疗（PCI）后患者的不良事件相关，但这两个因素密切相关。本研究评估了老年营养风险指数（GNRI）这一营养风险评估工具在对有无衰弱患者的预后分层中的效用。
我们使用了2020年6月至2022年9月的一项前瞻性多中心注册研究（SAKURA PCI2抗栓注册研究）的数据。本研究纳入了973例行PCI术的患者[年龄：72（61，79）岁]且有可用数据。根据临床衰弱量表（CFS）评分（CFS≥4定义为脆弱性衰弱）和GNRI值（GNRI<92定义为高营养风险）将患者分为四组。
在所有患者中，67例（6.9%）有脆弱性衰弱且GNRI<92，115例（11.8%）有脆弱性衰弱且GNRI≥92，98例（10.1%）无衰弱且GNRI<92，693例（71.2%）无衰弱且GNRI≥92。在中位随访737（565 - 956）天期间，Kaplan-Meier曲线显示，无论衰弱状态如何，GNRI<92的患者发生包括全因死亡、非致命性心肌梗死、支架血栓形成、因心力衰竭住院、出血学术研究联盟3或5级出血事件、中风和静脉血栓栓塞在内的复合不良事件的发生率更高（对数秩检验，两者p均<0.05）。在调整潜在混杂因素后，GNRI<92的脆弱性衰弱组复合不良事件发生率最高，与GNRI≥92的非衰弱组相比，风险比为2.51（95%置信区间1.59 - 3.95，p<0.001）。
衰弱和营养不良均与PCI术后患者的不良结局显著相关，营养不良无论衰弱状态如何均有影响。特别是GNRI作为一种有价值的预后工具，增强了PCI术后衰弱患者的风险分层。
