Association Between Prognostic Nutritional Index and Clinical Outcomes After Percutaneous Coronary Intervention in Elderly Patients with Chronic Total Occlusion

Q: What are the key findings of this study?

Each 1-unit increase in baseline Prognostic Nutritional Index was associated with a 15% reduced risk of all-cause mortality (HR 0.85) in elderly patients after successful CTO-PCI.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Chronic total occlusion (CTO) after successful percutaneous coronary intervention (PCI) (n=745). Intervention: Prognostic nutritional index (PNI) vs. Lower PNI. Primary outcome: All-cause mortality (HR 0.85, 95% CI 0.81-0.90, p=<0.001).

Q: What does this research mean for the field?

Lower baseline prognostic nutritional index (PNI) is associated with higher risks of long-term all-cause mortality and major adverse cardiovascular events in elderly patients following successful percutaneous coronary intervention for chronic total occlusion. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To investigate the association between the prognostic nutritional index (PNI) and long-term all-cause mortality and major adverse cardiovascular events (MACE) in elderly patients with chronic total occlusion (CTO) after successful percutaneous coronary intervention (PCI).

Jiquan Xiao; Song Wen; Renshang Xu; Qi Wan; Xiang He; Yusi Huang; Wenzhi Hu; Bin Zhang; Huimin Yu

doi:10.3390/jcdd13090464

September 14, 2026Journal of Cardiovascular Development and DiseaseOpen Access

Association Between Prognostic Nutritional Index and Clinical Outcomes After Percutaneous Coronary Intervention in Elderly Patients with Chronic Total Occlusion

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Key result

Higher baseline PNI linked to ~15% lower mortality per unit in elderly CTO-PCI patients.

HR 0.85
95% CI 0.81-0.90
P<0.001
n=745

Figures

Why the study?

The study aimed to evaluate the association between the prognostic nutritional index and long-term all-cause mortality and MACEs in elderly patients with chronic total occlusion following successful PCI.

Is baseline prognostic nutritional index associated with long-term all-cause mortality and MACE in elderly patients with chronic total occlusion after successful percutaneous coronary intervention?

Key Points

To investigate the association between the prognostic nutritional index (PNI) and long-term all-cause mortality and major adverse cardiovascular events (MACE) in elderly patients with chronic total occlusion (CTO) after successful percutaneous coronary intervention (PCI).
Retrospective single-center cohort study evaluating 745 consecutive patients aged ≥ 60 years who underwent successful CTO-PCI between February 2011 and April 2023.
The primary endpoint was all-cause mortality, and the secondary endpoint was MACE (all-cause mortality, non-fatal myocardial infarction, stroke, or target-vessel revascularization) over a median follow-up of 813 days.
Associations were analyzed using Cox proportional hazards models and restricted cubic spline (RCS) regressions across PNI tertiles (T1 lowest, T2 middle, T3 highest).
During follow-up, 58 (7.8%) all-cause deaths and 101 (13.6%) MACE occurred, with all-cause mortality decreasing across tertiles (16.5% vs. 3.6% vs. 3.2%, p < 0.001) and MACE decreasing across tertiles (22.9% vs. 8.9% vs. 8.9%, p < 0.001).
In primary multivariable models, each 1-unit increase in PNI was associated with reduced all-cause mortality (HR 0.85, 95% CI 0.81–0.90; p < 0.001) and reduced MACE (HR 0.92, 95% CI 0.88–0.96; p < 0.001).
Compared with T1, all-cause mortality was lower in T2 (HR 0.21, 95% CI 0.10–0.44; p < 0.001) and T3 (HR 0.24, 95% CI 0.11–0.52; p = 0.003), while MACE was also lower in T2 (HR 0.38, 95% CI 0.23–0.63; p = 0.002) and T3 (HR 0.49, 95% CI 0.30–0.82; p = 0.007).

Study Design

Type

Cohort (n=745)

Multicenter

No

Structured PICO

Is baseline prognostic nutritional index associated with long-term all-cause mortality and MACE in elderly patients with chronic total occlusion after successful percutaneous coronary intervention?

P

Population

745 elderly patients (aged ≥ 60 years) with successfully revascularized chronic total occlusion followed for a median of 813 days.

E

Exposure

Prognostic nutritional index (PNI) calculated from baseline serum albumin and lymphocyte count

C

Comparator

Comparison across PNI tertiles (T1 ≤ 43.55, T2 43.55-49.10, T3 > 49.10) and as a continuous variable

O

Outcome

All-cause mortalityhard clinical

Main Result

Hazard Ratio: 0.85 (95% CI 0.81–0.9)

p-value: p=<0.001

Lower baseline prognostic nutritional index is independently associated with higher risks of long-term all-cause mortality and MACE in elderly patients after successful CTO-PCI.

Limitations

Single-center retrospective design susceptible to selection bias and residual confounding
PNI was measured only once at baseline, without serial nutritional or inflammatory changes
Unmeasured frailty and global disease burden may confound the observed associations
Extended enrollment period spanned substantial changes in PCI techniques and clinical management
Small numbers of non-fatal MI and stroke events precluded robust multivariable modeling
Nonlinear RCS findings were based on sparse observations and sensitive to spline specification
Limited number of outcome events constrained the number of covariates in multivariable models, risking overfitting
Study population was recruited in China, which may limit generalizability to other populations
Single-center retrospective design susceptible to selection bias and residual confounding.
PNI was measured only once at baseline, and serial nutritional or inflammatory changes were unavailable.
Detailed dietary intake, physical activity, and validated frailty assessments were not systematically collected.
Extended enrollment period (2011-2023) spanned substantial changes in PCI techniques, secondary-prevention strategies, and clinical management.
Small numbers of non-fatal MI and stroke events precluded robust multivariable modeling of these components.
Limited number of outcome events constrained the number of covariates that could be reliably included in the multivariable models.

Implication

PNI may refine mortality risk stratification after CTO-PCI; hypothesis-generating for nutritional interventions in this population.

Abstract

Background: This study aimed to investigate the association between the prognostic nutritional index (PNI) and long-term all-cause mortality and major adverse cardiovascular events (MACEs) in elderly patients with chronic total occlusion (CTO) after successful percutaneous coronary intervention (PCI). Methods: This retrospective study enrolled 745 consecutive patients aged ≥ 60 years with successfully revascularized CTO between February 2011 and April 2023. All-cause mortality was the primary endpoint. MACE, defined as the first occurrence of all-cause mortality, non-fatal myocardial infarction, stroke, or target-vessel revascularization (TVR), was the secondary endpoint. Cox proportional hazards models and restricted cubic spline (RCS) analyses were used to evaluate associations. Results: During a median follow-up of 813 days, 58 (7.8%) all-cause mortality and 101 (13.6%) MACE occurred. In the primary multivariable model (Model 2), each 1-unit increase in PNI was associated with a 15% reduced risk of all-cause mortality (HR 0.85, 95% CI 0.81–0.90; p < 0.001) and an 8% reduced risk of MACE (HR 0.92, 95% CI 0.88–0.96; p < 0.001). Compared with the T1 group, patients in the T2 group had a significantly lower risk of all-cause mortality (HR = 0.21, 95% CI: 0.10–0.44; p < 0.001) and MACE (HR = 0.38, 95% CI: 0.23–0.63; p = 0.002). Similarly, the T3 group showed a significantly lower risk of all-cause mortality (HR = 0.24, 95% CI: 0.11–0.52; p = 0.003) and MACE (HR = 0.49, 95% CI: 0.30–0.82; p = 0.007). These associations remained directionally consistent in exploratory models with more extensive covariate adjustment. RCS indicated a linear association between PNI and all-cause mortality (p = 0.959) and a nonlinear association with MACE (p = 0.017). Conclusion: In this single-center retrospective cohort of elderly patients after successful CTO-PCI, lower baseline PNI was associated with higher risks of all-cause mortality and MACE. PNI may be a useful risk stratification tool, but its clinical utility requires confirmation in prospective, externally validated studies before implementation.

Discussion

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Cite This Study

Xiao et al. (2026) conducted a cohort in Chronic total occlusion (CTO) after successful percutaneous coronary intervention (PCI) (n=745). Prognostic nutritional index (PNI) vs. Lower PNI was evaluated on All-cause mortality (HR 0.85, 95% CI 0.81-0.90, p=<0.001). Each 1-unit increase in baseline Prognostic Nutritional Index was associated with a 15% reduced risk of all-cause mortality (HR 0.85) in elderly patients after successful CTO-PCI.

synapsesocial.com/papers/6aa90187eed42882c1fc1a3f https://doi.org/10.3390/jcdd13090464

Topics

Percutaneous coronary intervention

Chronic total occlusion PCI

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Association Between Prognostic Nutritional Index and Clinical Outcomes After Percutaneous Coronary Intervention in Elderly Patients with Chronic Total Occlusion

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Association Between Prognostic Nutritional Index and Clinical Outcomes After Percutaneous Coronary Intervention in Elderly Patients with Chronic Total Occlusion

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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