Prognostic value of malnutrition using geriatric nutritional risk index in patients with coronary chronic total occlusion after percutaneous coronary intervention

Abstract

Malnutrition is associated with poor prognosis in a wide range of chronic illnesses, however, the impact of malnutrition on long-term outcomes of patients at advanced stages of atherosclerosis, coronary chronic artery occlusion (CTO), is not known. This study aims to investigate the relationship between malnutrition and adverse cardiovascular events in patients with CTO after percutaneous coronary intervention (PCI). Baseline malnutrition risk was determined in 669 patients with CTO after PCI in this study. All patients were divided into 3 groups according to 3 categories of the geriatric nutritional risk index (GNRI): moderate to severe, GNRI of <92 (n=70); low, GNRI of 92-98 (n=197); and absence of risk, GNRI of ≥98 (n=402). The primary endpoint was all-cause mortality and the secondary endpoint was major adverse cardiovascular events (MACE). Average age in this study was 65.32±9.97 years old. More than one-third of patients were at risk of malnutrition (moderate to severe: 10.5%; low: 29.4%; and absence of risk: 60.1%). Over a median follow-up of 33 months, compared to those with absent risk for malnutrition, moderate to severe risk was associated with significantly increased risk for the all-cause death, cardiovascular death and MACE (hazard ratio [HR]: 2.90, 95% confidence interval [CI]: 1.43 to 5.87, P for trend=0.002; HR: 3.72, 95% CI: 1.42 to 9.77, P for trend=0.010; HR: 1.76, 95% CI: 1.02 to 3.03, P for trend=0.040; respectively) after adjustment for baseline variables. Moreover, addition of the GNRI score significantly raised the predictive value for the all-cause death (0.383, p=0.004 and 0.022, p=0.011, NRI and IDI respectively), cardiovascular death (0.488, p<0.001 and 0.013, p=0.014, NRI and IDI respectively) and MACE (0.368, p=0.004 and 0.014, p=0.008, NRI and IDI respectively) as compared to traditional factors. Malnutrition assessed by the GNRI score on admission was an independent predictor for adverse cardiovascular events in CTO patients after PCI. Addition of the GNRI score to the existing risk prediction model significantly increased the predictive ability for cardiovascular events in CTO patients after PCI.