Intervention therapy versus conservative therapy of non-ST elevation myocardial infarction patients with malnutrition : a multi-center real-world study

Background Malnutrition is strongly associated with increased mortality and cardiovascular events. In patients with non-ST-segment elevation myocardial infarction (NSTEMI), malnutrition may further complicate the clinical course and outcomes, and also impact the risk-benefit balance of percutaneous coronary intervention (PCI).Whether conservative therapy or intervention therapy is more beneficial in NSTEMI patients with malnutrition remains unclear. Purpose This study aims to compare the clinical outcomes of conservative therapy and intervention therapy in NSTEMI patients with malnutrition. Methods This study included a NSTEMI cohort from 82 secondary or tertiary hospitals between January 1, 2010 and March 31, 2024. Nutritional status was categorized based on the Controlling Nutritional Status score (CONUT), which calculated based on serum albumin, lymphocyte count, and cholesterol. A score of 0 to 1 is considered normal, while scores >2 indicate malnutrition. Patients were divided into intervention therapy and conservative therapy groups. The primary outcome was net adverse clinical events (NACEs) defined as major adverse cardiac or cerebral events (MACCE, including cardiac death, myocardial infarction, stroke and any revascularization) and bleeding events (BARC grade ≥ 3) in 1 year. Cox multivariable regression analysis was used to assess the association between treatment strategy and outcomes. Propensity score matching (PSM) was used to adjust the confounding factors. Survival was plotted with the Kaplan–Meier curve. Results Among 18,722 NSTEMI patients with malnutrition, 6,447 patients received intervention treatment and 12,275 received conservative treatment. Multivariate Cox regression analysis revealed that intervention treatment reduced 1-year MACCE (aHR:0.522, 95%CI:0.484-0.523, P < 0.001) and NACE (aHR: 0.462, 95%CI: 0.421-0.507, P < 0.001). These findings remained consistent in the 1:1 PSM cohort (n = 9,458), with MACCE (aHR:0.506, 95%CI:0.465-0.551, P < 0.001) and NACE (aHR:0.471, 95%CI:0.423-0.524, P < 0.001). Kaplan-Meier curve analysis also revealed a significant reduction in the incidence of MACCE and NACE in the intervention group. Conclusion NSTEMI patients concurrent malnutrition who were treated with intervention treatment exhibited improved outcomes.These findings highlight the clinical value of intervention treatment in this high-risk patient population.Cox analysis of primary outcomes. Kaplan-Meier Curve for primary outcomes.