Elsevier

The American Journal of Cardiology

Volume 157, 15 October 2021, Pages 71-78
The American Journal of Cardiology

Impact of the Geriatric Nutritional Risk Index in Patients Undergoing Transcatheter Aortic Valve Implantation

https://doi.org/10.1016/j.amjcard.2021.07.016Get rights and content

Several studies have shown that nutritional indexes are associated with cardiovascular events; however, limited studies have investigated the prognostic value of the Geriatric Nutritional Risk Index (GNRI) in patients undergoing transcatheter aortic valve implantation (TAVI). We aimed to evaluate the clinical impact of GNRI in patients undergoing TAVI. This single-center retrospective study analyzed consecutive patients treated with TAVI, stratified into groups according to their median baseline GNRI. The primary endpoint was 2-year all-cause mortality. In total, 968 patients with a mean age of 82.1 years and a median Society of Thoracic Surgeons (STS) score of 4.8% who underwent TAVI were included. The median GNRI was 103. Compared with the high-GNRI group (GNRI≥103, n = 451), the low-GNRI group (GNRI<103, n = 517) had higher STS scores and renal insufficiency rates. The 2-year all-cause mortality was significantly higher in the low-GNRI group than in the high-GNRI group (24.9% vs. 9.3%, p<0.001), despite no significant differences in procedural and clinical outcomes between the groups. On multivariable analysis, lower GNRI was independently associated with higher 2-year all-cause mortality (adjusted hazard ratio: 1.07; 95% confidence interval: 1.05-1.10; p<0.001). The GNRI retained its predictive value in subgroup analyses stratified by age (>75 vs. ≤75 years) and STS score (≥4 vs. <4). In conclusion, The GNRI is an important surrogate marker for predicting prognosis and mortality in patients undergoing TAVI.

Section snippets

Methods

We retrospectively reviewed 1681 consecutive patients with severe AS who underwent TAVI at the Cedars-Sinai Medical Center between November 2013 and December 2017. Transthoracic echocardiography was performed to assess the severity of AS. All patients were diagnosed with severe AS with aortic valve area (AVA)<1.0 cm2, mean pressure gradient≥40 mmHg, or peak velocity≥4.0 m/s. Informed consent was obtained from all patients prior to the TAVI procedure. All data were collected from an established

Results

The baseline characteristics of the study patients are shown in Table 1. The mean age of the entire cohort was 82.1±7.1 years, with 81% of the participants being older than 75 years of age. The median STS score was 4.8, and 58% of the patients were male. The flowchart of patient exclusion in this study is shown in Figure 1. Among 1681 patients, 713 were excluded according to the exclusion criteria, and 968 patients were included in the analysis. The GNRI distribution in this cohort is shown in

Discussion

This is the first report of a large US population that evaluated the prognostic value of the GNRI in patients undergoing TAVI. Summarizing the findings, GNRI was independently associated with 2-year all-cause mortality and was shown to be useful for risk stratification even in younger and low-risk patients. The GNRI was first reported in 2005 by Bouillanne et al.4 to predict the risk of complications, such as bedsores, infections, and mortality associated with malnutrition, in hospitalized

Author disclosures

Dr. Makkar received grant support from Edwards Lifesciences Corporation; he is a consultant for Abbott Vascular, Cordis, and Medtronic and holds equity in Entourage Medical. Dr. Chakravarty is a consultant, proctor, and speaker for Edwards Lifesciences and Medtronic; he is a consultant for Abbott Lifesciences, and he is a consultant and speaker for Boston Scientific. Other authors have no conflicts of interest to disclose.

Acknowledgment

None.

Disclosures

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper

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