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

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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.

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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.

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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

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  1. Hideki Wada
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  2. Tomotaka Dohi
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  3. Katsumi Miyauchi
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  4. Hirohisa Endo
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Correspondence to Tomotaka Dohi.

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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

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

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