Author + information
- Received May 28, 2020
- Revision received June 14, 2020
- Accepted June 18, 2020
- Published online August 10, 2020.
- Sergio Raposeiras Roubín, MD, PhDa,b,c,∗ (, )@S_Raposeiras,
- Emad Abu Assi, MD, PhDa,b,
- María Cespón Fernandez, MDa,
- Cristina Barreiro Pardal, MD, PhDd,
- Andrea Lizancos Castro, MDa,
- Jose Antonio Parada, MDa,
- David Dobarro Pérez, MDa,b,
- Sonia Blanco Prieto, MDa,
- Xavier Rossello, MD, PhDc,e,
- Borja Ibanez, MD, PhDc,f,g and
- Andrés Íñiguez Romo, MD, PhDa,b
- aCardiology Department, University Hospital Álvaro Cunqueiro, Vigo, Spain
- bHealth Research Institute Galicia Sur, Vigo, Spain
- cCentro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- dUniversity Hospital Montecelo, Pontevedra, Spain
- eCardiology Department and Health Research Institute of the Balearic Islands, University Hospital Son Espases, Palma, Spain
- fCardiology Department, Hospital Fundación Jiménez Díaz, Madrid, Spain
- gCentro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Spain
- ↵∗Address for correspondence:
Dr. Sergio Raposeiras Roubín, Cardiology Department, Hospital Álvaro Cunqueiro, Estrada de Clara Campoamor, 341, 36213 Vigo, Pontevedra, Spain.
Background Malnutrition is associated with poor prognosis in a wide range of illnesses. However, its prognostic impact in patients with acute coronary syndrome (ACS) is not well known.
Objectives This study sought to report the prevalence, clinical associations, and prognostic consequences of malnutrition in patients with ACS.
Methods In this study, the Controlling Nutritional Status (CONUT) score, the Nutritional Risk Index (NRI), and the Prognostic Nutritional Index (PNI) was applied to 5,062 consecutive patients with ACS. The relationships between malnutrition risk and all-cause mortality and major cardiovascular events (MACEs) (cardiovascular mortality, reinfarction, or ischemic stroke) were examined.
Results According to the CONUT score, NRI, and PNI, 11.2%, 39.5%, and 8.9% patients were moderately or severely malnourished, respectively; 71.8% were at least mildly malnourished by at least 1 score. Although worse scores were most strongly related to lower body mass index, between 8.4% and 36.7% of patients with a body mass index of ≥25 kg/m2 were moderately or severely malnourished, depending on the nutritional index used. During a median follow-up of 3.6 years (interquartile range: 1.3 to 5.3 years), 830 (16.4%) patients died, and 1,048 (20.7%) had MACEs. Compared with good nutritional status, malnutrition was associated with significantly increased risk for all-cause death (adjusted hazard ratio for moderate and severe degrees of malnutrition, respectively: 2.02 [95% confidence interval (CI): 1.65 to 2.49] and 3.65 [95% CI: 2.41 to 5.51] for the CONUT score, 1.40 [95% CI: 1.17 to 1.68] and 2.87 [95% CI: 2.17 to 3.79] for the NRI, and 1.71 [95% CI: 1.37 to 2.15] and 1.95 [95% CI: 1.55 to 2.45] for the PNI score; p values <0.001 for all nutritional indexes). Similar results were found for the CONUT score and PNI regarding MACEs. All risk scores improve the predictive ability of the GRACE (Global Registry of Acute Coronary Events) risk score for both all-cause mortality and MACEs.
Conclusions Malnutrition is common among patients with ACS and is strongly associated with increased mortality and cardiovascular events. Clinical trials are needed to prospectively evaluate the efficacy of nutritional interventions on outcomes in patients with ACS.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Fatima Rodriguez, MD, MPH, served as Guest Editor for this paper. Deepak L. Bhatt, MD, MPH, served as Guest Editor-in-Chief for this paper.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.
- Received May 28, 2020.
- Revision received June 14, 2020.
- Accepted June 18, 2020.
- 2020 American College of Cardiology Foundation
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