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Prognostic impact of nutritional status assessed by the Controlling Nutritional Status score in patients with stable coronary artery disease undergoing percutaneous coronary intervention

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Abstract

Background

Recently, malnutrition has been shown to be related to worse clinical outcomes in patients with heart failure. However, the association between nutritional status and clinical outcomes in patients with coronary artery disease (CAD) remains unclear. We investigated the prognostic value of malnutrition assessed by the Controlling Nutritional Status (CONUT; range 0–12, higher = worse, consisting of serum albumin, cholesterol and lymphocytes) score in patients with CAD.

Methods

The CONUT score was measured on admission in a total of 1987 patients with stable CAD who underwent elective percutaneous coronary intervention (PCI) between 2000 and 2011. Patients were divided into two groups according to their CONUT score (0–1 vs. ≥2). The incidence of major adverse cardiac events (MACE), including all-cause death and non-fatal myocardial infarction, was evaluated.

Results

The median CONUT score was 1 (interquartile range 0–2). During the median follow-up of 7.4 years, 342 MACE occurred (17.2%). Kaplan–Meier curves revealed that patients with high CONUT scores had higher rates of MACE (log-rank p < 0.0001). High CONUT scores showed a significant increase in the incidence of MACE compared with low CONUT scores, even after adjusting for confounding factors (hazard ratio: 1.64, 95% confidence interval 1.30–2.07, p < 0.0001). Adding CONUT scores to a baseline model with established risk factors improved the C-index (p = 0.02), net reclassification improvement (p = 0.004) and integrated discrimination improvement (p = 0.0003).

Conclusions

Nutritional status assessed by the CONUT score was significantly associated with long-term clinical outcomes in patients with CAD. Pre-PCI assessment of the CONUT score may provide useful prognostic information.

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Acknowledgements

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

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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, Shinichiro Doi, Takatoshi Kasai, Shinya Okazaki, Kikuo Isoda & Hiroyuki Daida

  2. Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan

    Hirokazu Konishi, Shuta Tsuboi, Manabu Ogita & Satoru Suwa

  3. Department of Cardiovascular Medicine, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan

    Ryo Naito

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  1. Hideki Wada
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Correspondence to Tomotaka Dohi.

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Wada, H., Dohi, T., Miyauchi, K. et al. 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 (2017). https://doi.org/10.1007/s00392-017-1132-z

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  • DOI: https://doi.org/10.1007/s00392-017-1132-z

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