Combined Effect of Inflammation and Malnutrition for Long-term Prognosis in Patients with Acute Coronary Syndrome: A Cohort Study

AbstractBackgroundDysregulated inflammation with superimposed malnutrition may constitute a significant threat in acute coronary syndrome (ACS), which needs to be elucidated. We aimed to explore the prevalence and combined predictive value of inflammation and malnutrition in ACS patients.MethodsPatients presenting with ACS undergoing percutaneous coronary intervention (PCI) were retrospectively included and stratified into four groups: nourished without elevated high-sensitivity C-reactive protein (hs-CRP), nourished with elevated hs-CRP, malnourished without elevated hs-CRP, and malnourished with elevated hs-CRP. Elevated hs-CRP was determined as over 2.2mg/L, and malnutrition was defined according to the nutritional risk index (NRI). The primary outcome was major adverse cardiovascular events (MACEs), the composite of cardiac mortality, non-fatal myocardial infarction, non-fatal stroke, and unplanned revascularization.ResultsA total of 1,743 patients were ultimately included; 646 (37%) presented elevated hs-CRP, and 119 (7%) were considered malnourished. During a median follow-up of 30 months, 351 (20.1%) MACEs occurred. The coexistence of malnutrition and elevated hs-CRP correlated with the worst outcomes among the four phenotypes, with a significantly increased risk of MACEs (adjusted hazard ratio: 2.446; 95% confidence interval: 1.464 - 4.089; p <0.001). In the subgroup analysis, NRI displayed MACEs-predicting value merely among patients with elevated hs-CRP rather than those without (p for interaction = 0.005), suggesting the modifying effect of inflammation; simultaneously, the prognostic implications of hs-CRP were influenced by patients’ baseline nutritional status, as it only existed in malnourished patients (p for interaction < 0.001).ConclusionsAmong patients with ACS undergoing PCI, the double burden of inflammation and malnutrition signifies poorer outcomes, and their prognostic implications may be amplified by each other, which would provide implications to facilitate more individualized ACS care.