P3626Malnutrition is a major factor to affect prognosis of coronary artery disease patients with myocardial damage
Authors: Kanda D , Ikeda Y , Sonoda T , Kosedo I , Yoshino S , Takumi T , Ohishi M 
Published: October 2019

Abstract

Background
Malnutrition is the important factor to cause frailty and sarcopenia which affect the prognosis of cardiovascular diseases. However, the effect of malnutrition on prognosis of coronary artery disease (CAD) patients with myocardial damage is still uncertain.

Purpose
The aim of the present study was to investigate the effect of malnutrition on prognosis of CAD patients with myocardial damage who received percutaneous coronary intervention (PCI).

Methods
The subjects were 241 CAD patients with myocardial damage due to myocardial ischemia by coronary artery stenosis or occlusion. These patients underwent successful revascularization for CAD by PCI using second-generation drug eluting stents and discharged. Geriatric Nutritional Risk Index (GNRI) was used to assess nutritional status in this study, and patients with GNRI<92 at baseline were defined as malnutrition group. The association between MACCE (major cardiovascular and cerebrovascular events) after discharged and patient's characteristics including nutritional status at baseline were assessed.

Results
The mean follow-up period was 546±310 days, with a maximum follow-up duration of 1092 days. MACCE within 3 years after PCI were 42 cases (17%) and malnutrition group had high rate of MACCE (38 vs. 11%, P<0.01) compared with non- malnutrition group. In malnutrition group, age (77±9 vs. 67±11 years, P<0.01) and high-sensitivity C-reactive protein (hs-CRP) level (5.52±6.63 vs. 0.72±1.86 mg/dl, P<0.01) were higher than those of non-malnutrition group. The serum albumin (Alb) level (3.0±0.5 vs. 4.0±0.4 mg/dL, P<0.01), hemoglobin (Hb) (10.4±1.9 vs. 12.8±2.4 g/dL, P<0.01), total cholesterol (151.8±32 vs. 174.1±41.6 mg/dL, P<0.01), triglycerides (96.9±49.1 vs. 140.6±128.3 mg/dL, P<0.01), and left ventricular ejection fraction (LVEF) (50.2±15.9 vs. 55.9±15.3%, P=0.03) were lower in malnutrition group than those in non-malnutrition group. Moreover, malnutrition group had lower rate of hemodialysis (HD) (35 vs. 65%, P<0.01), dyslipidemia (16 vs. 84%, P<0.01) and using of statins (16 vs. 83%, P=0.02) than those in non-malnutrition group. As a result of Cox proportional hazards analysis, MACCE was associated with age [hazard ratio (HR): 1.04, 95% confidence interval (CI): 1.01–1.07, p p<0.01)], hs-CRP (HR: 1.08, 95% CI: 1.03–1.11, p<0.01), HD (HR: 2.63, 95% CI: 1.51–4.58, p<0.01) and malnutrition (HR: 3.69, 95% CI: 2.11–6.42, p<0.01) in the univariate analysis. The multivariate Cox proportional hazards analysis revealed that HD (HR: 2.24, 95% CI: 1.24–4.08, p<0.01) and malnutrition (HR: 2.10, 95% CI: 1.04–4.23, p=0.03) were significantly associated with MACCE. Furthermore, malnutrition additively facilitated incidence of MACCE among patients underwent HD (GNRI <92+HD: HR 4.19, 95% CI: 2.22–7.88, p<0.001, GNRI >92+HD: HR 1.26, 95% CI: 0.65–2.47, p=0.493).

Conclusions
In CAD patients with myocardial damage, malnutrition (GNRI<92) is a major risk factor for MACCE after PCI.