Key result
Malnutrition, defined by a Geriatric Nutritional Risk Index < 92.0, significantly increased the risk of all-cause death beyond 1 month after percutaneous coronary intervention in patients with acute myocardial infarction (HR 3.10).
Why the study?
Malnutrition affects the prognosis of cardiovascular disease, but its impact defined by the Geriatric Nutritional Risk Index on mortality in AMI patients undergoing PCI needed investigation.
Does malnutrition (GNRI < 92.0) increase the risk of all-cause death in AMI patients undergoing PCI?
Cohort (n=268)
No
Does malnutrition (GNRI < 92.0) increase the risk of all-cause death in AMI patients undergoing PCI?
Hazard Ratio: 3.1 (95% CI 1.7–8.96)
Absolute Event Rate: 16% vs 4%
p-value: p=0.037
Malnutrition, as assessed by the Geriatric Nutritional Risk Index (GNRI), is a strong independent predictor of both short- and long-term mortality in AMI patients undergoing PCI.
Malnutrition (GNRI <92) was associated with higher late mortality after AMI PCI; leaves open whether nutritional intervention improves survival.
BACKGROUND: Malnutrition affects the prognosis of cardiovascular disease. Acute myocardial infarction (AMI) has been a major cause of death around the world. Thus, we investigated the impact of malnutrition as defined by Geriatric Nutritional Risk Index (GNRI) on mortality in AMI patients. METHODS: In 268 consecutive AMI patients who underwent percutaneous coronary intervention (PCI), associations between all-cause death and baseline characteristics including malnutrition (GNRI < 92.0) and Global Registry of Acute Coronary Events (GRACE) risk score were assessed. RESULTS: Thirty-three patients died after PCI. Mortality was higher in the 51 malnourished patients than in the 217 non-malnourished patients, both within 1 month after PCI (p < 0.001) and beyond 1 month after PCI (p = 0.017). Multivariate Cox proportional hazards regression modelling using age, left ventricular ejection fraction and GRACE risk score showed malnutrition correlated significantly with all-cause death within 1 month after PCI (hazard ratio [HR] 7.04; 95% confidence interval [CI] 2.30-21.51; p < 0.001) and beyond 1 month after PCI (HR 3.10; 95% CI 1.70-8.96; p = 0.037). There were no significant differences in area under the receiver-operating characteristic (ROC) curve between GRACE risk score and GNRI for predicting all-cause death within 1 month after PCI (0.90 vs. 0.81; p = 0.074) or beyond 1 month after PCI (0.69 vs. 0.71; p = 0.87). Calibration plots comparing actual and predicted mortality confirmed that GNRI (p = 0.006) was more predictive of outcome than GRACE risk score (p = 0.85) beyond 1 month after PCI. Furthermore, comparison of p-value for interaction of malnutrition and GRACE risk score for all-cause death within 1 month after PCI, beyond 1 month after PCI, and the full follow-up period after PCI were p = 0.62, p = 0.64 and p = 0.38, respectively. CONCLUSIONS: GNRI may have a potential for predicting the mortality in AMI patients especially in beyond 1 month after PCI, separate from GRACE risk score. Assessment of nutritional status may help stratify the risk of AMI mortality.
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Kanda et al. (2022) conducted a cohort in Acute myocardial infarction (n=268). Malnutrition (GNRI < 92.0) vs. Non-malnourished (GNRI ≥ 92.0) was evaluated on All-cause death beyond 1 month after PCI (HR 3.10, 95% CI 1.70-8.96, p=0.037). Malnutrition, defined by a Geriatric Nutritional Risk Index < 92.0, significantly increased the risk of all-cause death beyond 1 month after percutaneous coronary intervention in patients with acute myocardial infarction (HR 3.10).
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