Prevalence and Prognostic Significance of Malnutrition in Patients With Acute Coronary Syndrome

Roubín, Sergio Raposeiras; Assi, Emad Abu; Fernández, María Cespón; Pardal, Cristina Barreiro; Castro, Andrea Lizancos; Parada, José Antonio; Pérez, David Dobarro; Prieto, Sergio; Rosselló, Xavier; Ibáñez, Borja; Romo, Andrés Íñiguez

doi:10.1016/j.jacc.2020.06.058

Cited by 126 publications

(164 citation statements)

References 27 publications

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“…The prevalence of malnutrition increases with age and has been reported at rates varying from 29% to 61% in different series [23]. Similar to the results of the study by Roubin et al, in our study of patients with ACS, between 40% and 60% of participants were classified as malnourished based on CONUT and GNRI scores, while only 6.3% of them had malnutrition according to the PNI score distribution [12]. In elderly patients with CAD, malnutrition is common due to the effects of concomitant disease, stress reaction, drug usage, anxiety or depression and is independently associated with the risk of all-cause death [23].…”

Section: Discussionsupporting

confidence: 90%

Predicting One-Year Deaths and Major Adverse Vascular Events with the Controlling Nutritional Status Score in Elderly Patients with Non–ST-Elevated Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Kalyoncuoğlu

Katkat

Biter

et al. 2021

JCM

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The prognostic value of malnutrition in elderly patients with non-ST-elevated myocardial infarction (NSTEMI) is not fully understood. Nutritional characteristics were evaluated by novel Controlling Nutritional status (CONUT), the prognostic nutritional index (PNI) and the geriatric nutritional risk index (GNRI) scores. The impact of these scores on major outcomes in 253 NSTEMI patients over 60 years and older were assessed. Compared to those with good nutritional status; malnourished patients had more major adverse cardiac and cerebrovascular events (MACCEs) at 1-year follow up. Multivariable cox regression analysis revealed that CONUT (hazard ratio = 1.372; p < 0.01) was independent predictor of MACCEs, whereas PNI (p = 0.44) and GNRI (p = 0.52) were not. The discriminating power of the CONUT (AUC: 0.79) was adequate and significantly superior to both the PNI (AUC: 0.68) and the GNRI (AUC: 0.60), with a p-value for both < 0.01. Patients with elevated CONUT exhibited the highest event rate for all-cause mortality and MACCEs in survival analysis (p < 0.01). We conclude that malnutrition is strongly associated with adverse outcomes in older patients with NSTEMI. In fact, the CONUT score adequately predicts one-year MACCEs among elderly NSTEMI patients who achieve complete revascularization after coronary intervention.

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Section: Discussionsupporting

confidence: 90%

Predicting One-Year Deaths and Major Adverse Vascular Events with the Controlling Nutritional Status Score in Elderly Patients with Non–ST-Elevated Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Kalyoncuoğlu

Katkat

Biter

et al. 2021

JCM

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“…The malnutrition rate of patients with low LDL-C level was much higher than that of patients with high LDL-C level. This was also observed in other studies, highlighting the importance of nutritional status [10,11]. Roubín et al's nding showed that in patients with ACS 38.5%, 10.4% and 0.9% patients were mildly, moderately and severely malnourished according to CONUT score, respectively [10].…”

Section: Discussionsupporting

confidence: 63%

“…Roubín et al's nding showed that in patients with ACS 38.5%, 10.4% and 0.9% patients were mildly, moderately and severely malnourished according to CONUT score, respectively [10]. Roubín et al and Wada et al found that nutritional status assessed by the CONUT score was signi cantly associated with long-term clinical outcomes in patients with CAD [10,11].…”

Section: Discussionmentioning

confidence: 97%

“…LDL-C concentration was highly correlated with total cholesterol level which is an indicator of nutritional status [8,9]. Meanwhile, malnutrition is common among patients with CAD and is strongly associated with increased long-term mortality [10,11]. Thus, low LDL-C level may represent underlying malnutrition, which was related to the paradox.…”

Section: Introductionmentioning

confidence: 99%

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Malnutrition Affects Cholesterol Paradox in Coronary Artery Disease: a 41,229 Chinese Cohort Study

Wang¹,

Liu²,

Chen³

et al. 2021

Preprint

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Background: Several studies found that baseline low LDL-C concentration was associated with poor prognosis in patients with acute coronary syndrome (ACS), which was called “cholesterol paradox”. Low LDL-C concentration may reflect underlying malnutrition, which was strongly associated with increased mortality. We objected to investigate the cholesterol paradox in patients with CAD and the effects of malnutrition.Method: A total of 41,229 CAD patients admitted to Guangdong Provincial People's Hospital in China were included in this study from January 2007 to December 2018, and divided into two groups (LDL-C < 1.8 mmol/L, n=4,863; LDL-C ≥ 1.8 mmol/L, n = 36,366). We used Kaplan-Meier method and Cox regression analyses to assess the association between LDL-C levels and long-term all-cause mortality and the effect of malnutrition. Result: In this real-world cohort (mean age 62.94 years; 74.94% male), there were 5257 incidents of all-cause death during a median follow-up of 5.20 years [Inter-quartile range (IQR): 3.05-7.78 years]. Kaplan–Meier analysis showed that low LDL-C levels were associated with worse prognosis. After adjusting for baseline confounders (e.g., age, sex and comorbidities, etc.), multivariate Cox regression analysis revealed that low LDL-C level (<1.8mmol/L) was not significantly associated with all-cause mortality (adjusted HR, 1.04; 95% CI, 0.96-1.24). After adjustment of nutritional status, risk of all-cause mortality of patients with low LDL-C level decreased (adjusted HR, 0.90; 95% CI, 0.83-0.98). In the final multivariate Cox model, low LDL-C level was related to better prognosis (adjusted HR, 0.91; 95% CI, 0.84-0.99).Conclusion: Our results demonstrate that the cholesterol paradox persisted in CAD patients, but disappeared after accounting for the effects of malnutrition.

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“…Malnutrition is associated with poor prognosis in a wide variety of diseases including cancer (4,5), renal disease requiring dialysis (6), end-stage liver disease (7) and heart failure (8)(9)(10). Malnutrition also influences adversely the prognosis of patients with ACS (11).…”

Section: Introductionmentioning

confidence: 99%

The role of nutritional indexes in predicting coronary artery disease severity in acute coronary syndrome

Tolunay¹,

Görmel²,

Asil³

et al. 2021

GMJ

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Recently, the prognostic value of PNI in various malignancies Aims: The purpose of this study is to evaluate the association between nutritional status and coronary artery disease (CAD) severity in patients with acute coronary syndrome (ACS).Methods: Patients with ACS who underwent coronary angiography were evaluated retrospectively. SYNTAX scores were calculated for each patient to determine the severity of CAD. The patients were divided into three groups based on their SYNTAX scores as low SYNTAX score (≤22), intermediate SYNTAX score (23-32) and high SYNTAX score (≥33). The Prognostic Nutritional Index (PNI) score was calculated with the formula using serum albumin and total lymphocyte count. The "The Control Nutritional Status (CONUT)" score was calculated by using three parameters which are serum albumin, total cholesterol and total lymphocyte count. Data on cardiovascular mortality and rehospitalization within six months of diagnosis were obtained from records. Results:The study included 177 patients with ACS. The mean age of patients was 63.34±10.94 years and 64.4% were male. Patients with high SYNTAX score had statistically significantly lower PNI score and higher CONUT score than patients with low and intermediate SYNTAX scores. There was a positive correlation between SYNTAX score and CONUT score (r=0.256, p=0.002), and a negative correlation between SYNTAX score and PNI score (r=-0.328, p<0.001). Within six months of ACS diagnosis, patients with cardiovascular mortality and rehospitalization had lower PNI scores and higher CONUT scores. According to multivariate logistic regression analysis, CONUT score was an independent predictor for high SYNTAX score (odds ratio=1.584; 95% confidence interval=1.014-2.473; p=0.043). Conclusions:In our study, nutritional status assessed by PNI and CONUT scores was associated with the extent of coronary atherosclerosis in patients with ACS.

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Prevalence and Prognostic Significance of Malnutrition in Patients With Acute Coronary Syndrome

Cited by 126 publications

References 27 publications

Predicting One-Year Deaths and Major Adverse Vascular Events with the Controlling Nutritional Status Score in Elderly Patients with Non–ST-Elevated Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Predicting One-Year Deaths and Major Adverse Vascular Events with the Controlling Nutritional Status Score in Elderly Patients with Non–ST-Elevated Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Malnutrition Affects Cholesterol Paradox in Coronary Artery Disease: a 41,229 Chinese Cohort Study

The role of nutritional indexes in predicting coronary artery disease severity in acute coronary syndrome

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