Yu Weixu, Luo Yanting, Cai Qingyuan, Yang Jin, Deng Wanling, Dong Ruimin, Xie Xujing
Department of Cardiology, Zhongshan Hospital Xiamen University, Xiamen, China.
Department of Cardiology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Front Cardiovasc Med. 2025 Jul 24;12:1596575. doi: 10.3389/fcvm.2025.1596575. eCollection 2025.
Malnutrition is increasingly recognized as a modifiable prognostic factor in myocardial infarction (MI), yet traditional nutritional assessment methods often fail to adequately capture lipid-related atherogenic risk. We introduced an innovative modified Controlling Nutritional Status (mCONUT) score, which replaces total cholesterol with non-HDL cholesterol, aiming to improve the stratification of atherosclerotic risk and to assess its prognostic utility in predicting MI outcomes.
In this retrospective cohort study, we analyzed a total of 3,730 patients diagnosed with MI, extracted from the MIMIC-IV database, and stratified them into Normal, Mild, and Worse groups based on the mCONUT score. After performing 1:1:1 propensity score matching, we selected 993 patients for comparative analysis. Multivariable Cox proportional hazards models, adjusted for clinical and demographic confounders, were employed to evaluate all-cause mortality at 180 days and 1 year.
Among 993 MI patients, the median age was 75 years (IQR 68-82) with 58.4% males ( = 580). Malnutrition severity (mCONUT ≥6) stratified prognostic risk: Worse group demonstrated progressive mortality increases (180-day: 13.9% vs. Normal 7.85%, = 0.037; 1-year: 31.4% vs. 21.2%, = 0.011), alongside lower BMI, extended hospitalization, reduced hypertension, higher CKD incidence, and diminished revascularization (all < 0.05). Multivariable analyses confirmed graded mortality risk: 180-day (Model 1: adjusted HR 1.58, = 0.009; Model 2: HR 1.46, = 0.031) and 1-year (Model 1: HR 1.61, = 0.002; Model 2: HR 1.52, = 0.008). Consistency across subgroups was observed, with heightened vulnerability in males, hypertensives (interaction = 0.004), diabetes and non-white individuals.
The mCONUT score has emerged as a robust multidimensional biomarker for predicting MI prognosis, with worse malnutrition (mCONUT ≥ 6) being significantly associated with a 46%-61% elevation in mortality risk, demonstrating a clear linear dose-response relationship. Routine screening and tailored nutritional interventions should be prioritized in modern MI management practices.
营养不良日益被视为心肌梗死（MI）中一个可改变的预后因素，但传统的营养评估方法往往无法充分捕捉与脂质相关的动脉粥样硬化风险。我们引入了一种创新的改良控制营养状况（mCONUT）评分，用非高密度脂蛋白胆固醇取代总胆固醇，旨在改善动脉粥样硬化风险分层，并评估其在预测MI结局方面的预后效用。
在这项回顾性队列研究中，我们分析了从MIMIC-IV数据库中提取的总共3730例诊断为MI的患者，并根据mCONUT评分将他们分为正常、轻度和重度组。在进行1:1:1倾向评分匹配后，我们选择了993例患者进行比较分析。采用多变量Cox比例风险模型，并对临床和人口统计学混杂因素进行调整，以评估180天和1年时的全因死亡率。
在993例MI患者中，中位年龄为75岁（IQR 68-82），男性占58.4%（n = 580）。营养不良严重程度（mCONUT≥6）对预后风险进行分层：重度组的死亡率呈逐步上升趋势（180天：13.9% 对正常组的7.85%，P = 0.037；1年：31.4% 对21.2%，P = 0.011），同时伴有较低的BMI、更长的住院时间、更低的高血压患病率、更高的慢性肾脏病发病率以及更低的血运重建率（均P < 0.05）。多变量分析证实了死亡率风险的分级：180天（模型1：调整后HR 1.58，P = 0.009；模型2：HR 1.46，P = 0.031）和1年（模型1：HR 1.61，P = 0.002；模型2：HR 1.52，P = 0.008）。在各亚组中观察到一致性，男性、高血压患者（交互作用P = 0.004）、糖尿病患者和非白人个体的脆弱性更高。
mCONUT评分已成为预测MI预后的一种强大的多维生物标志物，营养不良程度越严重（mCONUT≥6）与死亡风险升高46%-61%显著相关，呈现出明显的线性剂量反应关系。在现代MI管理实践中，应优先进行常规筛查和针对性的营养干预。
