The prognostic impact of objective nutritional indices in elderly patients with ST-elevation myocardial infarction undergoing primary coronary intervention

Basta, Giuseppina; Chatzianagnostou, Kyriazoula; Paradossi, Umberto; Botto, Nicoletta; Turco, Serena Del; Taddei, Alessandro; Berti, Sérgio; Mazzone, Annamaria

doi:10.1016/j.ijcard.2016.07.039

Cited by 88 publications

(93 citation statements)

References 16 publications

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“…Malnutrition has emerged as another important player in this equation of inflammation–atherosclerosis interaction and may represent a risk factor and/or prognostic indicator of cardiac outcomes . Another study showed that, in STEMI patients, the long‐term risk of all‐cause death was higher in patients with malnutrition, expressed by a CONUT score <3 . However, patients included in the present study had both STEMI‐ and non‐STEMI‐type AMI, and we investigated the acute phase of AMI with its hemodynamic complications.…”

Section: Discussionmentioning

confidence: 89%

“…13 Another study showed that, in STEMI patients, the long-term risk of all-cause death was higher in patients with malnutrition, expressed by a CONUT score <3. 21 However, patients included in the present study had both STEMI-and non-STEMI-type AMI, and we investigated the acute phase of AMI with its hemodynamic complications. According to the authors' knowledge, this is the first study that demonstrated a higher inotropic requirement and LOS in malnourished patients after AMI.…”

Section: Discussionmentioning

confidence: 99%

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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

Rus

Chițu

Benedek

et al. 2019

Nutrition & Dietetics

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Aim The aim of the present study was to assess the influence of nutritional status, as expressed by Controlling Nutritional Status (CONUT) and Geriatric Nutritional Risk Index (GNRI) scores, on the inflammatory response following acute myocardial infarction (AMI) and the impact of an altered nutritional status and increased systemic inflammation on immediate evolution following AMI. Methods This was an observational prospective study in which we used the CONUT score and GNRI on 86 consecutive patients with AMI receiving primary revascularisation, divided into a well‐nourished group (CONUT score 0–2, n = 68) and moderate‐to‐severe nutritional deficit group (CONUT score ≥ 3, n = 18). Inflammatory status was assessed on the basis of highly sensitive C‐reactive protein (hs‐CRP) at baseline and on day 5. Results Malnourished patients presented significantly higher levels of serum hs‐CRP at baseline (33.6 ± 35.02 mg/dL vs 10.26 ± 25.93 mg/dL, P < 0.0001) and day 5 (52.8 ± 46.25 mg/dL vs 17.04 ± 24.78 mg/dL, P < 0.0001). GNRI values showed a weak but significant correlation with serum hs‐CRP at baseline (r = −0.26, P = 0.01) and day 5 (r = −0.44, P < 0.0001). Patients with altered nutritional status presented more frequent deterioration of their haemodynamical status, requiring inotropic support (P = 0.002) and longer hospitalisation in the acute cardiac care unit (4.27 ± 2.60 vs 2.85 ± 0.73 days, P = 0.005). Patients requiring intravenous inotropics had a higher CONUT score (2.31 ± 1.7 vs 1.17 ± 1.27, P = 0.01), lower GNRI (102.0 ± 5.31 vs 98.56 ± 5.2, P = 0.02) and higher hs‐CRP levels at baseline and day 5 (31.40 ± 46.57 vs 18.52 ± 32.98, P = 0.04 and 46.04 ± 51.50 vs 19.60 ± 46.05, P = 0.006). Conclusions Malnourished patients with AMI had more expressed inflammation, increased blood vulnerability and worse outcomes.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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

Rus

Chițu

Benedek

et al. 2019

Nutrition & Dietetics

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“…The relationship between immunologic parameters including neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and coronary artery disease has been established in large-scale studies 21,22 . The impact of the nutritional status in cardiovascular diseases has not been well-established although severe weight-loss has been found to be a predictor of mortality in patients with ACS and acute heart failure 4,23 . All of these studies have found that the patients with lower PNI tended to have more than one comorbidity; and after multivariate analysis, the lower PNI remained a significant risk factor of adverse clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

The impact of prognostic nutritional index on coronary flow reserve in patients with inflammatory bowel disease

Çalışkan¹,

Tatlısu²,

Kahraman³

et al. 2019

MMJ

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Objective:The recurring inflammation of mucosal layer of intestines is known as inflammatory bowel disease (IBD), which can be accompanied by nutritional deficiencies. The association between inflammation and coronary artery disease has been established. Coronary flow reserve (CFR), which is an established method to evaluate combined microvascular and epicardial flow of coronary arteries, can be assessed by using transthoracic echocardiography. The aim of this study was to evaluate the association of Prognostic Nutritional Index (PNI) with CFR in IBD patients. Method: This prospective study included 101 patients with IBD. These patients were compared to control group (n=32). PNI was calculated by using serum albumin level and lymphocyte count. CFR was assessed by using Doppler echocardiography. Results: Multivariate regression analysis indicated that the presence of IBD, age (>40 years) and decreased PNI (<53.8) independently predict impairment of CFR. The area under the curve (AUC) was 75.1% (95% CI:0.664-0.838), and PNI levels were significant predictor of low CFR (p<0.001). Conclusion: This study showed that PNI, which is calculated using the serum level of albumin and lymphocyte count, is a strong predictor of decreased CFR in IBD patients in remission. Our findings support previous studies showing the relationship between PNI and coronary artery disease. This immunonutritional index has only two components and is easy to calculate, and inexpensive.Keywords: Coronary flow reserve, inflammatory bowel disease, prognostic nutritional index ÖZ Amaç: Nutrisyonel yetersizliklerin eşlik edebildiği bağırsak mukoza katmanının tekrarlayıcı inflamasyonu, inflamatuvar bağırsak hastalığı (İBH) olarak bilinmektedir. İnflamasyon ve koroner arter hastalığının ilişkisi ortaya konulmuştur. Mikrovasküler ve epikardiyal akımı kombine bir şekilde değerlendirebilen koroner akım rezervi (KAR), transtorasik ekokardiyografi ile değerlendirilebilir. Bu çalışmanın amacı, İBH hastalarında prognostik nutrisyonel indeks (PNI) ile KAR arasındaki ilişkiyi değerlendirmekti. Yöntem: Bu çalışma, prospektif olarak dahil edilen 101 İBH hastasını içermektedir. Bu hastalar kontrol grubu (n=32) ile karşılaştırılmıştır. PNI, serum albümin düzeyi, lenfosit sayısı kullanılarak hesaplanmıştır. KAR, doppler ekokardiyografi ile değerlendirilmiştir. Bulgular: Çok değişkenli regresyon analizi İBH varlığı, yaş (>40) ve azalmış PNI'nın (<53,8) KAR'daki bozulmayı bağımsız bir şekilde predikte ettiğini ortaya çıkarmıştır. Eğri altında kalan alan (AUC) %75'di (95% CI: 0,664-0,838) ve PNI seviyesi düşük KAR için anlamlı bir prediktördü (p<0,001). Sonuç: Bu çalışma göstermiştir ki serum albümin seviyesi, lenfosit sayısı ile hesaplanan PNI, remisyondaki İBH hastalarında azalmış KAR için güçlü bir prediktördür. Çalışmamız PNI ile koroner arter hastalığı ilişkisini gösteren önceki çalışmaları desteklemektedir. Bu immunonutrisyonel indeks sadece iki komponente sahiptir, kolayca hesaplanabilir ve ucuzdur.Anahtar kelimeler: Koroner akım rezervi, inflamatuvar bağırsak h...

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“…The nutritional status of the patients has been recently studied as having significant impact on prognosis, in a sense that malnutrition can negatively impact patient outcomes in various chronic disorders, from oncological to cardiovascular disease, and from chronic heart failure to stable coronary artery disease, myocardial infarction, or lower limb ischemia. [16][17][18][19][20][21][22][23][24] Evaluation of the nutritional status could become a new prognostic marker for such patients, while dietary supplements and malnutrition corrective therapies may beneficially influence the prognosis of patients with chronic heart failure. 25,26 The CONUT score (Controlling Nutri- impact mortality in the general population.…”

Section: Discussionmentioning

confidence: 99%

“…The score reflects the immune and nutritional status and can indicate systemic inflammation, and is associated with higher mortality in surgical, medical, cardiovascular, and oncological patients. [19][20][21][22] Although the negative influence of a poor nutritional status has been evaluated in previous studies on the prognosis and outcome of stable and decompensated chronic heart failure patients, 16,21,23 as well as in patients with stable coronary artery disease or hypertension, 18,24 the usefulness of the CONUT and PNI scores as markers for blood vulnerability on the early outcome of subjects with ST and non-ST elevation AMI is still not completely elucidated.…”

Section: Introductionmentioning

confidence: 99%

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

Rus

Opincariu

Hodaş

et al. 2018

Journal of Cardiovascular Emergencies

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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.

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The prognostic impact of objective nutritional indices in elderly patients with ST-elevation myocardial infarction undergoing primary coronary intervention

Cited by 88 publications

References 16 publications

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

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

The impact of prognostic nutritional index on coronary flow reserve in patients with inflammatory bowel disease

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

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