Skip to main content

Advertisement

Springer Nature Link
Log in

Combined effect of nutritional status on long-term outcomes in patients with coronary artery disease undergoing percutaneous coronary intervention

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

Previous studies have reported the prognostic value of objective nutritional indices such as the Controlling Nutritional Status (CONUT) score, Geriatric Nutritional Risk Index (GNRI) and Prognostic Nutritional Index (PNI). However, the effects of these indices in patients with coronary artery disease (CAD) who have undergone percutaneous coronary intervention (PCI) remain unclear. Furthermore, there are insufficient data to combine these indices. A total of 1984 patients who underwent elective PCI were enrolled. The Combined Objective Nutritional Score was determined by assigning 1 point each for high CONUT score (3–12), low GNRI (< 98) or low PNI (< 45). Patients were grouped into normal nutritional status (0 points), mild-to-moderate malnutrition (1–2 points) and severe malnutrition (3 points). Incidences of all-cause death and cardiac death were evaluated. Among the 1984 patients, 514 (25.9%) and 244 (12.3%) had mild-to-moderate and severe malnutrition, respectively. During follow-up (median 7.4 years), 293 all-cause deaths were identified, including 92 cardiac deaths. Kaplan–Meier curves showed ongoing divergence in rates of death among nutritional statuses determined by the novel score (log rank test, p < 0.0001). Multivariate Cox hazard analysis showed that patients with a Combined Objective Nutritional Score of 3 showed 2.91-fold (95% confidence interval (CI) 2.10–4.00; p < 0.0001) and 2.16-fold (95% CI 1.15–3.92; p = 0.02) increases in risk of mortality and cardiac mortality compared with patients with a Combined Objective Nutritional Score of 0. In conclusion, malnutrition as evaluated by the Combined Objective Nutritional Score was significantly associated with worse long-term cardiovascular outcomes among CAD patients who underwent PCI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Lin H, Zhang H, Lin Z, Li X, Kong X, Sun G (2016) Review of nutritional screening and assessment tools and clinical outcomes in heart failure. Heart Fail Rev 21:549–565

    Article  CAS  Google Scholar 

  2. Kalantar-Zadeh K, Anker SD, Horwich TB, Fonarow GC (2008) Nutritional and anti-inflammatory interventions in chronic heart failure. Am J Cardiol 101:89E–103E

    Article  CAS  Google Scholar 

  3. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, Gonzalez-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 37:2129–2200

    Article  Google Scholar 

  4. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL (2013) 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 62:e147–e239

    Article  Google Scholar 

  5. Bonilla-Palomas JL, Gamez-Lopez AL, Castillo-Dominguez JC, Moreno-Conde M, Lopez Ibanez MC, Alhambra Exposito R, Ramiro Ortega E, Anguita-Sanchez MP, Villar-Raez A (2016) Nutritional intervention in malnourished hospitalized patients with heart failure. Arch Med Res 47:535–540

    Article  Google Scholar 

  6. Ignacio de Ulibarri J, Gonzalez-Madrono A, de Villar NG, Gonzalez P, Gonzalez B, Mancha A, Rodriguez F, Fernandez G (2005) CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp 20:38–45

    CAS  PubMed  Google Scholar 

  7. Bouillanne O, Morineau G, Dupont C, Coulombel I, Vincent JP, Nicolis I, Benazeth S, Cynober L, Aussel C (2005) Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr 82:777–783

    Article  CAS  Google Scholar 

  8. Buzby GP, Mullen JL, Matthews DC, Hobbs CL, Rosato EF (1980) Prognostic nutritional index in gastrointestinal surgery. Am J Surg 139:160–167

    Article  CAS  Google Scholar 

  9. Onodera T, Goseki N, Kosaki G (1984) Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi 85:1001–1005

    CAS  PubMed  Google Scholar 

  10. Agra Bermejo RM, Gonzalez Ferreiro R, Varela Roman A, Gomez Otero I, Kreidieh O, Conde Sabaris P, Rodriguez-Manero M, Moure Gonzalez M, Seoane Blanco A, Virgos Lamela A, Garcia Castelo A, Gonzalez Juanatey JR (2017) Nutritional status is related to heart failure severity and hospital readmissions in acute heart failure. Int J Cardiol 230:108–114

    Article  Google Scholar 

  11. Nishi I, Seo Y, Hamada-Harimura Y, Sato K, Sai S, Yamamoto M, Ishizu T, Sugano A, Obara K, Wu L, Suzuki S, Koike A, Aonuma K (2017) Nutritional screening based on the controlling nutritional status (CONUT) score at the time of admission is useful for long-term prognostic prediction in patients with heart failure requiring hospitalization. Heart Vessels 32:1337–1349

    Article  Google Scholar 

  12. Shirakabe A, Hata N, Kobayashi N, Okazaki H, Matsushita M, Shibata Y, Nishigoori S, Uchiyama S, Asai K, Shimizu W (2018) The prognostic impact of malnutrition in patients with severely decompensated acute heart failure, as assessed using the Prognostic Nutritional Index (PNI) and Controlling Nutritional Status (CONUT) score. Heart Vessels 33:134–144

    Article  Google Scholar 

  13. Cheng YL, Sung SH, Cheng HM, Hsu PF, Guo CY, Yu WC, Chen CH (2017) Prognostic nutritional index and the risk of mortality in patients with acute heart failure. J Am Heart Assoc 6:e004876

    PubMed  PubMed Central  Google Scholar 

  14. Honda Y, Nagai T, Iwakami N, Sugano Y, Honda S, Okada A, Asaumi Y, Aiba T, Noguchi T, Kusano K, Ogawa H, Yasuda S, Anzai T (2016) Usefulness of geriatric nutritional risk index for assessing nutritional status and its prognostic impact in patients aged ≥65 years with acute heart failure. Am J Cardiol 118:550–555

    Article  Google Scholar 

  15. Chen QJ, Qu HJ, Li DZ, Li XM, Zhu JJ, Xiang Y, Li L, Ma YT, Yang YN (2017) Prognostic nutritional index predicts clinical outcome in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Sci Rep 7:3285

    Article  Google Scholar 

  16. Wada H, Dohi T, Miyauchi K, Doi S, Konishi H, Naito R, Tsuboi S, Ogita M, Kasai T, Okazaki S, Isoda K, Suwa S, Daida H (2017) Prognostic impact of nutritional status assessed by the Controlling Nutritional Status score in patients with stable coronary artery disease undergoing percutaneous coronary intervention. Clin Res Cardiol 106:875–883

    Article  CAS  Google Scholar 

  17. Wada H, Dohi T, Miyauchi K, Doi S, Naito R, Konishi H, Tsuboi S, Ogita M, Kasai T, Hassan A, Okazaki S, Isoda K, Suwa S, Daida H (2017) Prognostic impact of the geriatric nutritional risk index on long-term outcomes in patients who underwent percutaneous coronary intervention. Am J Cardiol 119:1740–1745

    Article  Google Scholar 

  18. Teramoto T, Sasaki J, Ishibashi S, Birou S, Daida H, Dohi S, Egusa G, Hiro T, Hirobe K, Iida M, Kihara S, Kinoshita M, Maruyama C, Ohta T, Okamura T, Yamashita S, Yokode M, Yokote K (2013) Diagnostic criteria for dyslipidemia. J Atheroscler Thromb 20:655–660

    Article  Google Scholar 

  19. Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, Yamagata K, Tomino Y, Yokoyama H, Hishida A, Collaborators developing the Japanese equation for estimated GFR (2009) Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis 53:982–992

    Article  CAS  Google Scholar 

  20. Shah B, Sucher K, Hollenbeck CB (2006) Comparison of ideal body weight equations and published height-weight tables with body mass index tables for healthy adults in the United States. Nutr Clin Pract 21:312–319

    Article  Google Scholar 

  21. Nochioka K, Sakata Y, Takahashi J, Miyata S, Miura M, Takada T, Fukumoto Y, Shiba N, Shimokawa H (2013) Prognostic impact of nutritional status in asymptomatic patients with cardiac diseases: a report from the CHART-2 Study. Circ J 77:2318–2326

    Article  Google Scholar 

  22. Basta G, Chatzianagnostou K, Paradossi U, Botto N, Del Turco S, Taddei A, Berti S, Mazzone A (2016) The prognostic impact of objective nutritional indices in elderly patients with ST-elevation myocardial infarction undergoing primary coronary intervention. Int J Cardiol 221:987–992

    Article  Google Scholar 

  23. Seo SH, Kim SE, Kang YK, Ryoo BY, Ryu MH, Jeong JH, Kang SS, Yang M, Lee JE, Sung MK (2016) Association of nutritional status-related indices and chemotherapy-induced adverse events in gastric cancer patients. BMC Cancer 16:900

    Article  Google Scholar 

  24. Takahashi H, Ito Y, Ishii H, Aoyama T, Kamoi D, Kasuga H, Yasuda K, Maruyama S, Matsuo S, Murohara T, Yuzawa Y (2014) Geriatric nutritional risk index accurately predicts cardiovascular mortality in incident hemodialysis patients. J Cardiol 64:32–36

    Article  Google Scholar 

  25. Guigoz Y, Vellas B, Garry PJ (1996) Assessing the nutritional status of the elderly: the Mini Nutritional Assessment as part of the geriatric evaluation. Nutr Rev 54:S59–S65

    Article  CAS  Google Scholar 

  26. Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, Jeejeebhoy KN (1987) What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr 11:8–13

    Article  CAS  Google Scholar 

  27. Kalantar-Zadeh K, Block G, Horwich T, Fonarow GC (2004) Reverse epidemiology of conventional cardiovascular risk factors in patients with chronic heart failure. J Am Coll Cardiol 43:1439–1444

    Article  Google Scholar 

  28. Nakagomi A, Kohashi K, Morisawa T, Kosugi M, Endoh I, Kusama Y, Atarashi H, Shimizu W (2016) Nutritional status is associated with inflammation and predicts a poor outcome in patients with chronic heart failure. J Atheroscler Thromb 23:713–727

    Article  CAS  Google Scholar 

  29. Ko BJ, Chang Y, Jung HS, Yun KE, Kim CW, Park HS, Chung EC, Shin H, Ryu S (2016) Relationship between low relative muscle mass and coronary artery calcification in healthy adults. Arterioscler Thromb Vasc Biol 36:1016–1021

    Article  CAS  Google Scholar 

  30. von Haehling S, Doehner W, Anker SD (2007) Nutrition, metabolism, and the complex pathophysiology of cachexia in chronic heart failure. Cardiovasc Res 73:298–309

    Article  Google Scholar 

  31. Roche M, Rondeau P, Singh NR, Tarnus E, Bourdon E (2008) The antioxidant properties of serum albumin. FEBS Lett 582:1783–1787

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We are grateful to the staff of the Department of Cardiovascular Medicine at Juntendo University and the Department of Cardiology at Juntendo University Shizuoka Hospital. We also appreciate the secretarial assistance of Yumi Nozawa.

Author information

Authors and Affiliations

  1. Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan

    Hideki Wada, Tomotaka Dohi, Katsumi Miyauchi, Hirohisa Endo, Takatoshi Kasai, Shinya Okazaki, Kikuo Isoda & Hiroyuki Daida

  2. Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan

    Shuta Tsuboi, Manabu Ogita & Satoru Suwa

Authors
  1. Hideki Wada
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Tomotaka Dohi
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Katsumi Miyauchi
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Hirohisa Endo
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Shuta Tsuboi
    View author publications

    You can also search for this author inPubMed Google Scholar

  6. Manabu Ogita
    View author publications

    You can also search for this author inPubMed Google Scholar

  7. Takatoshi Kasai
    View author publications

    You can also search for this author inPubMed Google Scholar

  8. Shinya Okazaki
    View author publications

    You can also search for this author inPubMed Google Scholar

  9. Kikuo Isoda
    View author publications

    You can also search for this author inPubMed Google Scholar

  10. Satoru Suwa
    View author publications

    You can also search for this author inPubMed Google Scholar

  11. Hiroyuki Daida
    View author publications

    You can also search for this author inPubMed Google Scholar

Corresponding author

Correspondence to Tomotaka Dohi.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wada, H., Dohi, T., Miyauchi, K. et al. Combined effect of nutritional status on long-term outcomes in patients with coronary artery disease undergoing percutaneous coronary intervention. Heart Vessels 33, 1445–1452 (2018). https://doi.org/10.1007/s00380-018-1201-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-018-1201-x

Keywords