Impact of hypoalbuminemia, frailty, and body mass index on early prognosis in older patients (≥85 years) with ST-elevation myocardial infarction

Sujino, Yasumori; Tanno, Jun; Nakano, Shintaro; Funada, Shuhei; Hosoi, Yoshie; Senbonmatsu, Takaaki; Nishimura, Shigeyuki

doi:10.1016/j.jjcc.2014.12.001

Cited by 67 publications

(64 citation statements)

References 33 publications

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“…Furthermore, our study is the first to reveal higher mortality among AMI with PEM in the United States. These findings are consistent with the result from the KAMIR‐based study mentioned above and other Asian studies that have used hypoalbuminemia, waist‐to‐hip ratio, body mass index, or other computed measures of nutrition as a surrogate for malnutrition among patients with ST‐elevated AMI undergoing PCI. Our results also concur with studies of PEM in other conditions such as heart failure, acute ischemic stroke, sepsis, hip fractures, and PEM among patients hospitalized in a general medical and surgical floor .…”

Section: Discussionsupporting

confidence: 89%

Inferior Outcomes of Patients With Acute Myocardial Infarction and Comorbid Protein‐Energy Malnutrition

Adejumo

Adegbala

et al. 2019

J Parenter Enteral Nutr

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Background Protein‐energy malnutrition (PEM) diminishes amino acid and energy availability, impairing the body's healing capability after injury, such as in myocardial damage following acute myocardial infarction (AMI). Aims We sought to investigate the influence of PEM on clinical outcomes of AMI. Methods We identified records with a primary discharge diagnosis of AMI from the Nationwide Inpatient Sample (2012–2014), stratified by concomitant PEM. We matched PEM to no‐PEM (1:1) using a greedy algorithm–based propensity methodology and estimated the impact of PEM on health outcomes (SAS 9.4). Results Of the 332,644 hospitalizations for AMI, 11,675 had concomitant PEM accounting for roughly $US 1.5 billion and over 119,792 hospital days. PEM was associated with older age (74.43‐ vs. 66.90‐years; P < 0.0001), female sex (49.19% vs. 38.44%; P < 0.0001), black race (12.78% vs. 10.46%; P < 0.0001), and higher comorbidity burden (Deyo > 3: 32.77% vs. 16.69%; P < 0.0001). After propensity matching, PEM was associated with higher mortality (Adjusted odds ratio [AOR]: 1.59 [1.46–1.73]), cardiogenic shock (AOR: 2.26 [2.08–2.44]), discharge to secondary facilities (AOR: 2.21 [2.10–2.33]), charges ($135,500 [$131,956–139,139] vs. $81,084 [$79,241–82,970]), cardiac artery bypass surgery (AOR:1.81 [1.66–1.97]), intra‐aortic balloon pump placement (AOR: 1.83 [1.65–2.04]) and longer length of stay (10.15‐ vs. 5.52‐days). Conclusions PEM is a predisposing factor for devastating clinical outcomes among AMI hospitalizations. Higher prevention, identification and management of PEM among high‐risk individuals (older age, female sex, and black race) residing in the community are needed.

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Section: Discussionsupporting

confidence: 89%

Inferior Outcomes of Patients With Acute Myocardial Infarction and Comorbid Protein‐Energy Malnutrition

Adejumo

Adegbala

et al. 2019

J Parenter Enteral Nutr

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“…Some single nutritional indices such as albumin have been shown to be closely associated with poor outcomes in patients with CHF 7, 8 . Additionally, to evaluate nutritional status, more complex indices, such as the prognostic nutritional index (PNI), have been developed and widely used 9–13 .…”

Section: Introductionmentioning

confidence: 99%

“…It seems that lower serum albumin levels are increased risk factors for coronary disease, which could, together with traditional risk factors, assist in confirming patients who are at risk of myocardial infarction (MI) 8, 9 . However, one study has shown that hypoalbuminemia was related to adverse events but not to mortality in patients with acute coronary syndrome.…”

Section: Introductionmentioning

confidence: 99%

Prognostic nutritional index predicts clinical outcome in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

Chen

et al. 2017

Sci Rep

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We aimed to investigate whether the prognostic nutritional index (PNI), a combined nutritional-inflammatory score based on serum albumin levels and lymphocyte count, was associated with mortality in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). From September 2011 to November 2014, 309 consecutive patients with STEMI undergoing pPCI were prospectively enrolled. Patients with a combined score of albumin (g/L) + 5 × total lymphocyte count × 109/L ≥ 45 or <45 were assigned a PNI score of 0 or 1, respectively. Of the 309 STEMI patients, 24 (7.74%) died in the hospital, and 15 (4.83%) died during long-term follow-up (median follow-up time, 19.5 [3–36] months). Compared to patients with a PNI of 0, patients with a PNI of 1 had significantly higher in-hospital (14.2% vs. 3.7%; P < 0.001) and long-term follow-up (21.7% vs. 6.9%, P < 0.001) mortality rates. PNI (1/0, HR, 2.414; 95% CI, 1.016 to 5.736; P = 0.046) was a significant independent predictor of mortality in patients with STEMI undergoing pPCI. Moreover, cumulative survival was significantly lower for patients with a PNI of 1 compared to patients with a PNI of 0 (78.3% vs. 93.1%, log-rank P < 0.001). PNI appears useful for the risk stratification of STEMI patients undergoing pPCI.

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“…Recognition of frailty has been of increasing importance of for cardiovascular health because the association of frailty and increased risk of cardiovascular disease has been recently reported (7), and frailty also adds extra prognostic significance to existing risk model (8). Frail older people were at significant higher risk of mortality and morbidity than non-frail older people across various kinds of cardiovascular diseases (9), encompassing stable coronary heart disease(10), acute coronary syndromes (11), heart failure (12), and surgical interventions (13). The importance of frailty for cardiovascular diseases is not only its prognostic impact, but also the benefits of therapeutic interventions for frailty also improve cardiovascular outcomes (14).…”

Section: Introductionmentioning

confidence: 99%

Association of Frailty and Cardiometabolic Risk Among Community-Dwelling Middle-Aged and Older People: Results from the I-Lan Longitudinal Aging Study

Hwang

Liu

Lee

et al. 2015

Rejuvenation Research

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The aim of this study was to evaluate the association of cardiometabolic risk and frailty through a community-based aging cohort in Taiwan In total, 1839 participants (men, 47.5%; mean age 63.9 ± 9.3 years) from the first wave of the I-Lan longitudinal cohort study, recruited between August of 2011 and August of 2013, were retrieved for the analysis of this cross-sectional study. Frailty was defined by Cardiovascular Health Study (CHS) criteria, encompassing un-intentional weight loss, slow walk speed, poor grip strength, exhaustion, and low activity. Comparisons between cardiometabolic risk and frailty status were performed after adjustment for age, hormone parameters, functional measurements, and skeletal muscle mass. Independent association of cardiometabolic risk and frailty status was identified through the multivariate logistic regression model. We found that the prevalence of frailty and pre-frial were 6.8% and 40.5%, respectively. Adjustments for age, blood pressure, low-density lipoprotein cholesterol (LDL-C), uric acid, creatinine, and carotid intima media thickness were not significantly associated with frailty. However, lower total cholesterol and high-density lipoprotein cholesterol (HDL-C), higher high-sensitivity C-reactive protein (hsCRP) and glycemia profiles were significantly associated with frailty. For hormone parameters, dehydroepiandrosterone sulfate (DHEA-S), insulin-like growth factor-1 (IGF-1), and free androgen index were not significantly associated with frailty after age adjustment. In a multivariate logistic regression model, abdominal obesity, homeostasis model assessment of insulin resistance (HOMA-IR), and hsCRP were significantly associated with frailty. The odds ratio (OR) for frailty was 3.57 (95% confidence interval [CI] 1.88-6.78, p < 0.001), 1.30 (95% CI 1.02-1.66, p = 0.032), and 1.66 (95% CI 1.10-2.49, p = 0.016), respectively, in a fully adjusted model. Conversely, higher total cholesterol was associated with a lower prevalence of frailty (OR = 0.44, 95% CI 0.22-0.89, p = 0.023) in the final model. In this study, abdominal obesity, insulin resistance, and inflammation were significantly associated with frailty, and the effect was independent of functional measurement and decline of skeletal muscle mass. An integrated approach targeted at cardiometabolic aging and frailty is needed in clinical practice.

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Impact of hypoalbuminemia, frailty, and body mass index on early prognosis in older patients (≥85 years) with ST-elevation myocardial infarction

Abstract: These findings indicate that the serum albumin level, CSHA-CFS score, and BMI, in addition to serum troponin I level, have an impact on the early prognosis of older patients with STEMI.

Cited by 67 publications

References 33 publications

Inferior Outcomes of Patients With Acute Myocardial Infarction and Comorbid Protein‐Energy Malnutrition

Inferior Outcomes of Patients With Acute Myocardial Infarction and Comorbid Protein‐Energy Malnutrition

Prognostic nutritional index predicts clinical outcome in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

Association of Frailty and Cardiometabolic Risk Among Community-Dwelling Middle-Aged and Older People: Results from the I-Lan Longitudinal Aging Study

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