Geriatric nutritional risk index is a predictor of recurrent percutaneous coronary intervention in patients with non-ST segment elevation myocardial infarction

Aim To investigate the relationship between malnutrition and follow-up cardiovascular (CV) events in non-
ST-segment elevation myocardial infarction (NSTEMI).
Material and methods A retrospective study was performed on 298 patients with NSTEMI. The baseline geriatric nutritional
risk index (GNRI) was calculated at the first visit. The patients were divided into three groups according
to the GNRI: >98, no-risk; 92 to ≤98, low risk; 82 to <92, moderate to high (MTH) risk. The study
endpoint was a composite of follow-up CV events, including all-cause mortality, non-valvular atrial
fibrillation (NVAF), hospitalizations, and need for repeat percutaneous coronary intervention (PCI).
Results Follow-up data showed that MTH risk group had significantly higher incidence of repeat PCI and all-
cause mortality compared to other groups (p<0.001). However, follow-up hospitalizations and NVAF
were similar between groups (p>0.05). The mean GNRI was 84.6 in patients needing repeat PCI and
99.8 in patients who did not require repeat PCI (p<0.001). Kaplan Meier survival analysis showed that
patients with MTH risk had significantly poorer survival (p<0.001). According to multivariate Cox
regression analysis, theMTH risk group (hazard ratio=5.372) was associated with increased mortality.
Conclusion GNRI value may have a potential role for the prediction of repeat PCI in patients with NSTEMI.

1. DiMaria-Ghalili RA, Amella E. Nutrition in Older Adults: Intervention and assessment can help curb the growing threat of malnutrition. American Journal of Nursing. 2005;105(3):40–50. DOI: 10.1097/00000446-200503000-00020

2. Lin H, Zhang H, Lin Z, Li X, Kong X, Sun G. Review of nutritional screening and assessment tools and clinical outcomes in heart failure. Heart Failure Reviews. 2016;21(5):549–65. DOI: 10.1007/s10741-016-9540-0

3. Bouillanne O, Morineau G, Dupont C, Coulombel I, Vincent J-P, Nicolis I et al. Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. The American Journal of Clinical Nutrition. 2005;82(4):777–83. DOI: 10.1093/ajcn/82.4.777

4. Masatoshi M, Takashi M, Hirohiko M, Yasushi U, Hitoshi N, Kunihiko S et al. Geriatric Nutritional Risk Index Predicts Cardiovascular Events in Patients at Risk for Heart Failure. Circulation Journal. 2018;82(6):1614–22. DOI: 10.1253/circj.CJ-17-0255

5. Davenport DL, Xenos ES, Hosokawa P, Radford J, Henderson WG, Endean ED. The influence of body mass index obesity status on vascular surgery 30-day morbidity and mortality. Journal of Vascular Surgery. 2009;49(1):140-147.e1. DOI: 10.1016/j.jvs.2008.08.052

6. Takahashi H, Ito Y, Ishii H, Aoyama T, Kamoi D, Kasuga H et al. Geriatric nutritional risk index accurately predicts cardiovascular mortality in incident hemodialysis patients. Journal of Cardiology. 2014;64(1):32–6. DOI: 10.1016/j.jjcc.2013.10.018

7. Yokoyama M, Watanabe T, Otaki Y, Watanabe K, Toshima T, Sugai T et al. Impact of Objective Malnutrition Status on the Clinical Outcomes in Patients With Peripheral Artery Disease Following Endovascular Therapy. Circulation Journal. 2018;82(3):847–56. DOI: 10.1253/circj.CJ-17-0731

8. Collet J-P, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. European Heart Journal. 2020;32(23):2999–3054. DOI: 10.1093/eurheartj/ehaa575

9. Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K et al. Revised Equations for Estimated GFR From Serum Creatinine in Japan. American Journal of Kidney Diseases. 2009;53(6):982–92. DOI: 10.1053/j.ajkd.2008.12.034

10. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. European Heart Journal. 2018;39(33):3021–104. DOI: 10.1093/eurheartj/ehy339

11. American Diabetes Association. Standards of Medical Care in Diabetes--2013. Diabetes Care. 2013;36(Suppl 1):S11–66. DOI: 10.2337/dc13-S011

12. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European Heart Journal. 2016;37(27):2129–200. DOI: 10.1093/eurheartj/ehw128

13. Kinugasa Y, Kato M, Sugihara S, Hirai M, Yamada K, Yanagihara K et al. Geriatric Nutritional Risk Index Predicts Functional Dependency and Mortality in Patients With Heart Failure With Preserved Ejection Fraction. Circulation Journal. 2013;77(3):705–11. DOI: 10.1253/circj.CJ-12-1091

14. Amarya S, Singh K, Sabharwal M. Changes during aging and their association with malnutrition. Journal of Clinical Gerontology and Geriatrics. 2015;6(3):78–84. DOI: 10.1016/j.jcgg.2015.05.003

15. Ożga E, Małgorzewicz S. Assessment of nutritional status of the elderly. Geriatria. 2013;7:1–6. [Av. at: https://www.akademiamedycyny.pl/wp-content/uploads/2016/05/201302_Geriatria_005.pdf]

16. Wong BW, Meredith A, Lin D, McManus BM. The Biological Role of Inflammation in Atherosclerosis. Canadian Journal of Cardiology. 2012;28(6):631–41. DOI: 10.1016/j.cjca.2012.06.023

17. Abd-El-Gawad WM, Abou-Hashem RM, El Maraghy MO, Amin GE. The validity of Geriatric Nutrition Risk Index: Simple tool for prediction of nutritional-related complication of hospitalized elderly patients. Comparison with Mini Nutritional Assessment. Clinical Nutrition. 2014;33(6):1108–16. DOI: 10.1016/j.clnu.2013.12.005

18. Narumi T, Arimoto T, Funayama A, Kadowaki S, Otaki Y, Nishiyama S et al. The prognostic importance of objective nutritional indexes in patients with chronic heart failure. Journal of Cardiology. 2013;62(5):307–13. DOI: 10.1016/j.jjcc.2013.05.007

19. Jia Y, Gao Y, Li D, Cao Y, Cheng Y, Li F et al. Geriatric Nutritional Risk Index Score Predicts Clinical Outcome in Patients With Acute ST-Segment Elevation Myocardial Infarction. Journal of Cardiovascular Nursing. 2020;35(6):E44–52. DOI: 10.1097/JCN.0000000000000674

20. Nadruz W, Kitzman D, Windham BG, Kucharska-Newton A, Butler K, Palta P et al. Cardiovascular Dysfunction and Frailty Among Older Adults in the Community: The ARIC Study. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2017;72(7):958–64. DOI: 10.1093/gerona/glw199

21. Emami A, Saitoh M, Valentova M, Sandek A, Evertz R, Ebner N et al. Comparison of sarcopenia and cachexia in men with chronic heart failure: results from the Studies Investigating Co-morbidities Aggravating Heart Failure (SICA-HF). European Journal of Heart Failure. 2018;20(11):1580–7. DOI: 10.1002/ejhf.1304

22. Cereda E, Klersy C, Pedrolli C, Cameletti B, Bonardi C, Quarleri L et al. The Geriatric Nutritional Risk Index predicts hospital length of stay and in-hospital weight loss in elderly patients. Clinical Nutrition. 2015;34(1):74–8. DOI: 10.1016/j.clnu.2014.01.017

23. Keskin M, Hayıroğlu Mİ, Keskin T, Kaya A, Tatlısu MA, Altay S et al. A novel and useful predictive indicator of prognosis in ST-segment elevation myocardial infarction, the prognostic nutritional index. Nutrition, Metabolism and Cardiovascular Diseases. 2017;27(5):438–46. DOI: 10.1016/j.numecd.2017.01.005

24. Yoo SH, Kook HY, Hong YJ, Kim JH, Ahn Y, Jeong MH. Influence of undernutrition at admission on clinical outcomes in patients with acute myocardial infarction. Journal of Cardiology. 2017;69(3):555–60. DOI: 10.1016/j.jjcc.2016.05.009

25. Gärtner S, Kraft M, Krüger J, Vogt LJ, Fiene M, Mayerle J et al. Geriatric nutritional risk index correlates with length of hospital stay and inflammatory markers in older inpatients. Clinical Nutrition. 2017;36(4):1048–53. DOI: 10.1016/j.clnu.2016.06.019

26. Matsuo Y, Kumakura H, Kanai H, Iwasaki T, Ichikawa S. The Geriatric Nutritional Risk Index Predicts Long-Term Survival and Cardiovascular or Limb Events in Peripheral Arterial Disease. Journal of Atherosclerosis and Thrombosis. 2020;27(2):134–43. DOI: 10.5551/jat.49767