Original Investigation
Prevalence and Prognostic Significance of Malnutrition in Patients With Acute Coronary Syndrome

https://doi.org/10.1016/j.jacc.2020.06.058Get rights and content
Under an Elsevier user license
open archive

Abstract

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.

Key Words

acute coronary syndrome
major cardiovascular events
malnutrition
mortality

Abbreviations and Acronyms

ACS
acute coronary syndromes
BMI
body mass index
CONUT
Controlling Nutritional Status
CV
cardiovascular
LVEF
left ventricular ejection fraction
MACE
major cardiovascular event
NRI
Nutritional Risk Index
NSTEMI
non–ST-segment elevation myocardial infarction
PCI
percutaneous coronary intervention
PNI
Prognostic Nutritional Index
STEMI
ST-segment elevation myocardial infarction

Cited by (0)

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.

Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.