Relationship Between Nutritional Risk Indices and Severity of Coronary Artery Disease in Patients With Acute Coronary Syndrome

BackgroundNutritional risk is increasingly recognized as an important but under-recognized factor associated with adverse cardiovascular status in patients with acute coronary syndrome (ACS).Lower nutritional reserve may reflect systemic inflammation, metabolic vulnerability, and greater coronary atherosclerotic burden. ObjectiveThis study aimed to evaluate the association between nutritional risk, assessed using the Nutritional Risk Index (NRI) and Geriatric NRI (GNRI), and angiographic severity of coronary artery disease (CAD), measured by the SYNTAX Score (SS), among patients with ACS. Materials and methodsThis cross-sectional study was conducted in the Department of Cardiology, Chittagong Medical College Hospital, Bangladesh, from April 2024 to March 2025.A total of 140 admitted patients with ACS who underwent coronary angiography during index hospitalization were enrolled through consecutive sampling.Nutritional status was assessed using the NRI for patients aged below 65 years and the GNRI for patients aged 65 years or above.Patients were categorized into no, low, and high nutritional risk groups.Angiographic severity was assessed using the SS and classified into low-, intermediate-, and high-risk categories. ResultsAmong 140 patients, 61 (43.6%) had some degree of nutritional risk, including 32 (22.9%) with low nutritional risk and 29 (20.7%) with high nutritional risk.Patients with nutritional risk were older and had lower serum albumin levels than those without nutritional risk.Higher SS and a greater frequency of multivessel disease were observed among patients with low and high nutritional risk.NRI/GNRI scores demonstrated a significant moderate negative correlation with SS (rₛ = -0.513,p < 0.001), indicating that lower nutritional index scores were associated with greater angiographic severity.Exploratory receiver operating characteristic (ROC) analysis suggested acceptable discriminatory ability of NRI/GNRI for identifying patients with high-risk SS.In multivariable linear regression analysis, NRI/GNRI score remained significantly negatively associated with SS after adjustment for demographic and clinical factors (B = -0.386,95% confidence interval (CI): -0.624 to -0.149; p = 0.002).Smoking, dyslipidemia, and sex were also significantly associated with SS. ConclusionsNutritional risk was common among patients with ACS and was significantly associated with greater angiographic severity and complexity of CAD.NRI/GNRI may provide simple, low-cost measures for identifying patients with a greater coronary atherosclerotic burden.However, the exploratory ROC findings require further validation before these indices can be recommended for clinical risk stratification.