Inter-relation between Altered Nutritional Status and Clinical Outcomes in Patients with Acute Myocardial Infarction Admitted in a Tertiary Intensive Cardiac Care Unit

Abstract

Background: The impact of nutritional status on the early outcome of subjects with acute myocardial infarction (AMI) is still not completely elucidated. This study aimed to assess the correlation between nutritional status, as expressed by the CONUT and PIN scores, and (1) clinical and laboratory characteristics, (2) complication rates, and (3) length of hospitalization, in patients with AMI. Materials and methods: We included 56 consecutive patients with AMI who underwent primary percutaneous intervention and stenting. Evaluation of the nutritional status was comprised in the calculation of the CONUT and PNI scores. The study population was divided into 2 groups according to the calculated CONUT score, as follows: group 1 – CONUT score <3 points (normal to mildly impaired nutritional status) and group 2 – CONUT score ≥3 points (moderate to severe malnutrition). The primary end-point of the study was the rate of in-hospital complications (left ventricular free wall rupture, hemodynamic instability requiring inotropic medication, high-degree atrioventricular block, the need for temporary cardiostimulation, supraventricular and ventricular arrhythmias and in-hospital cardiac arrest). The secondary end-points included the duration of hospitalization and the length of stay in the intensive cardiac care unit. Results: In total, 56 patients (44.64% with STEMI, 55.35% with NSTEMI) with a mean age of 61.96 ± 13.42 years, 58.92% males were included in the study. Group distribution was: group 1 – 76.78% (n = 43), group 2 – 23.21% (n = 23). There were no differences between the two groups regarding age, gender, cardiovascular risk factors, or comorbidities. PNI index in group 1 was 54.4 ± 10.4 and in group 2 41.1 ± 2.8, p <0.0001. Serum albumin was significantly lower in group 1 – 4.1 ± 0.3 vs. group 2 – 3.6 ± 0.3 (p <0.0001), similarly to total cholesterol levels (group 1 – 194.9 ± 41.5 vs. group 2 – 161.2 ± 58.2, p = 0.02). The complete blood cell count showed that group 2 presented lower levels of hematocrit (p = 0.003), hemoglobin (p = 0.002), and lymphocytes (p <0.0001) compared to group 1, but a significantly higher platelet count (p = 0.001), mean platelet volume (p = 0.03), neutrophil/lymphocyte (p <0.0001) and platelet/lymphocyte (p <0.0001) ratios, indicating enhanced blood thrombogenicity and inflammation. Regarding in-hospital complications, group 2 presented a higher rate of hemodynamic instability (group 1 – 11.6% vs. group 2 – 38.4%, p = 0.02). The overall hospitalization period was 7.7 ± 1.4 days in group 1 vs. 10.2 ± 4.8 days in group 2, p = 0.06; while the duration of stay in the intensive cardiac care unit was 2.6 ± 0.5 days in group 1 vs. 4.0 ± 2.5 days in group 2, p = 0.02. Conclusions: This study proved that nutritional deficit in acute myocardial patients who undergo revascularization is associated with an increased rate of in-hospital complications and with a longer observation time in a tertiary intensive cardiac care unit.

Nutritional Status and Clinical Outcomes of Cardiac Patients in Acute Settings

“…In this issue of the Journal of Cardiovascular Emergencies, Rus V. and colleagues have employed two practical and easy-to-use indexes for evaluation of nutritional status of cardiovascular patients admitted to an Intensive Cardiac Care Unit for acute ST (STEMI) and non-ST elevation (NSTEMI) myocardial infarction. 17 The authors have used the Controlling Nutritional Status (CO-NUT) and Prognostic Nutritional Index (PNI) scores in 56 consecutive patients and divided them in two groups: normal to mildly impaired nutritional status (CONUT score <3) and moderate to severely impaired nutritional status (CONUT score >3), respectively. 17 There were no significant differences between the two groups with regards to major CVRF, including age, smoking status, previous diagnosis of diabetes mellitus, hypertension, dyslipidemia, obesity, or previous angina pectoris/myocardial infarction.…”

Altered nutritional status, inflammation and systemic vulnerability in patients with acute myocardial infarction undergoing percutaneous coronary revascularisation: A prospective study in a level 3 cardiac critical care unit

“…In acute settings, malnutrition increases patient vulnerability, being associated with poorer outcomes, higher risk of complications and increased mortality. At the same time, hospital length of stay (LOS) and readmission rates are significantly increased in malnourished patients . However, when discussing patient vulnerability, a composite of variables should be accounted for, which in the case of a cardiovascular setting includes the vulnerability of the myocardial tissue, the vulnerability related to unstable atheromatous plaques and the systemic vulnerability of the blood…”

“…In acute myocardial infarction (AMI), the interaction between these three vulnerability components is reflected by the presence of unstable coronary atherosclerotic plaques, increased systemic inflammation and blood thrombogenicity (with increased coagulability and platelet aggregation) and the electrical instability caused by myocardial damage, with a higher risk of fatal arrhythmias …”

“…At the same time, hospital length of stay (LOS) and readmission rates are significantly increased in malnourished patients. [6][7][8] However, when discussing patient vulnerability, a composite of variables should be accounted for, which in the case of a cardiovascular setting includes the vulnerability of the myocardial tissue, the vulnerability related to unstable atheromatous plaques and the systemic vulnerability of the blood. 9 In acute myocardial infarction (AMI), the interaction between these three vulnerability components is reflected by the presence of unstable coronary atherosclerotic plaques, increased systemic inflammation and blood thrombogenicity (with increased coagulability and platelet aggregation) and the electrical instability caused by myocardial damage, with a higher risk of fatal arrhythmias.…”

“…9 In acute myocardial infarction (AMI), the interaction between these three vulnerability components is reflected by the presence of unstable coronary atherosclerotic plaques, increased systemic inflammation and blood thrombogenicity (with increased coagulability and platelet aggregation) and the electrical instability caused by myocardial damage, with a higher risk of fatal arrhythmias. 8,9 In order to quantify the risk of major cardiovascular event and/or post-event evolution of a cardiovascular vulnerable patient, comprehensive assessment and risk stratification would be very useful. This should probably include not only the evaluation of the vulnerable triad (plaque, myocardium and blood) but also the patient's underlying nutritional status.…”