Association of Pre-procedural Nutritional Indicators with Periprocedural Myocardial Infarction in Patients Undergoing Elective Percutaneous Coronary Intervention

Abstract

Nutritional risk is closely related to the poor prognosis of hospitalized patients. However, the association of pre-procedural nutritional risk with periprocedural myocardial infarction (PMI) after percutaneous coronary intervention (PCI) remains unclear.

A total of 22,267 patients who underwent elective PCI were enrolled in this retrospective cross-sectional study. Nutritional risk was evaluated by three nutritional risk assessment tools, namely, controlling nutritional status (CONUT), prognostic nutritional index (PNI), and geriatric nutritional risk index (GNRI). PMI after PCI was defined as elevation of cardiac troponin I (cTnI) values > 5 × 99th percentile upper reference limit. Linear regression analysis was performed to explore the association of nutritional risk assessment tools with cTnI fold elevation. Log-binomial regression analysis was conducted to determine the association of nutritional risk assessment tools with PMI.

The average age of the enrolled patients was 66.4 years old, and 2,647 of them (11.9%) suffered PMI after PCI. Multivariable linear regression analysis determined a linear association between nutritional risk assessment tools and cTnI fold elevation (CONUT: β = 0.220, 95% CI [0.088-0.352], P = 0.001; PNI: β = −0.105, 95% CI [−0.146 to −0.065], P < 0.001; GNRI: β = −0.090, 95% CI [−0.122 to −0.057], P < 0.001). Log-binomial regression analysis showed that nutritional risk assessment tools were strongly associated with PMI after PCI (CONUT [4-12 versus 0-1]: RR = 1.168, 95% CI [1.054-1.295], P = 0.003; PNI [< 44 versus ≥ 52]: RR = 1.168, 95% CI [1.038-1.315], P = 0.010; GNRI [< 98 versus ≥ 108]: RR = 1.128, 95% CI [1.006-1.264], P = 0.039).

Pre-procedural nutritional status, assessed by CONUT, PNI, and GNRI, was significantly and strongly associated with PMI in patients undergoing elective PCI.