Prognostic analysis of BMI, nutritional risk score (NRS2002), age, and heart failure in in-hospital mortality: An examination of interactions in acute myocardial infarction patients

BACKGROUND AND AIM: Acute myocardial infarction (AMI) remains a major cause of in-hospital mortality. This study aimed to assess the prognostic value of Body Mass Index (BMI), Nutritional Risk Score (NRS2002), age, and heart failure (HF), along with their key interactions, in predicting in-hospital mortality in AMI patients. METHODS AND RESULTS: A retrospective analysis was conducted on 945 AMI patients hospitalized between January 2017 and June 2021. Logistic regression models were used to identify associations with in-hospital mortality. Higher NRS2002 scores were independently linked to increased mortality, though the effect was less pronounced in HF patients (OR = 0.496, 95 % CI: 0.268-0.920, p = 0.026) compared to those without HF (OR = 2.897 per unit, 95 % CI: 1.721-4.878, p < 0.001). The presence of HF significantly raised mortality risk (OR = 15.437, 95 % CI: 3.578-66.605, p < 0.001). A significant interaction between age and BMI was found. In patients under 83 years, higher BMI was associated with lower mortality (OR = 0.872 per unit, 95 % CI: 0.790-0.962, p = 0.006), but in patients over 83, higher BMI increased mortality risk. Age itself remained a significant predictor (OR = 1.058 per year, 95 % CI: 1.012-1.106, p = 0.014). CONCLUSION: Nutritional status and HF significantly influence in-hospital mortality in AMI patients. BMI has an age-dependent effect on risk. Integrating BMI and NRS2002 into early risk stratification may enhance prognostic accuracy and support clinical decision-making.