Impact of the Malnutrition on Mortality in Elderly Patients Undergoing Percutaneous Coronary Intervention

Figures & data

Figure 1 Patient flow diagram.

Table 1 Malnutrition Screening Tools

		Risk of Malnutrition
		Absent	Mild	Moderate	Severe
CONUT, points		0–1	2–4	5–8	9–12
Formula	Serum albumin, g/dl	≥3.50	3.00–3.49	2.50–2.99	<2.50
	Albumin score	0	2	4	6
	Total cholesterol, mg/dl	≥180	140–179	100–139	<100
	Cholesterol score	0	1	2	3
	Lymphocytes, count/mL	≥1600	1200–1599	800–1199	<800
	Lymphocytes score	0	1	2	3

Abbreviation: CONUT, Controlling Nutritional Status.

Table 2 Baseline Characteristic in the Elder Patients Undergoing PCI Stratified by CONUT Score

Characteristics	Overall n=21,479	Absent n=7687	Mild n=10,350	Moderate n=3240	Severe n=202	P-value
Demographic characteristic
Male, n (%)	15,591 (72.59)	5091 (66.23)	7766 (75.03)	2567 (79.23)	167 (82.67)	<0.001
Age, years	69.53±6.59	68.15±6.06	69.82±6.62	71.66±6.95	72.88±6.98	<0.001
Coexisting conditions
AMI, n (%)	4682 (21.84)	949 (12.36)	2266 (21.94)	1356 (41.92)	111 (54.95)	<0.001
Hypertension, n (%)	13,488 (62.90)	4902 (63.84)	6495 (62.89)	1958 (60.53)	133 (65.84)	0.009
Atrial fibrillation, n (%)	612 (2.85)	181 (2.35)	299 (2.89)	123 (3.80)	9 (4.46)	<0.001
Pre-MI, n (%)	1290 (6.02)	406 (5.29)	675 (6.54)	198 (6.12)	11 (5.45)	0.006
DM, n (%)	6442 (30.04)	2242 (29.20)	3097 (29.99)	1032 (31.90)	71 (35.15)	0.015
eGFR< 60, n (%)	5151 (28.68)	1280 (20.73)	2500 (28.82)	1238 (42.44)	133 (68.21)	<0.001
Anemia, n (%)	8528 (39.70)	1872 (24.35)	4355 (42.08)	2139 (66.02)	162 (80.20)	<0.001
CAD, n (%)	21,437 (99.80)	7667 (99.74)	10,332 (99.83)	3236 (99.88)	202 (100.00)	0.369
CHF, n (%)	2356 (10.98)	528 (6.87)	1099 (10.63)	658 (20.36)	71 (35.15)	<0.001
LVEF<40%, n (%)	1331 (9.77)	324 (6.51)	619 (9.55)	354 (17.40)	34 (27.42)	<0.001
Laboratory examination
WBC, 10^9/L	8.00±2.78	7.83±2.23	7.90±2.72	8.62±3.71	9.84±4.50	<0.001
Hemoglobin, g/L	129.90±16.68	135.10±14.20	129.67±15.71	119.83±18.57	105.55±21.64	<0.001
LYM, 10^9/L	1.81±0.67	2.14±0.60	1.75±0.63	1.28±0.54	0.87±0.36	<0.001
Total cholesterol, mmol/L	4.49±1.17	5.09±1.07	4.26±1.08	3.88±1.06	3.29±0.83	<0.001
Albumin, g/L	35.60±4.23	38.51±2.56	35.29±3.36	30.38±3.34	24.63±3.09	<0.001
eGFR, mL/min/1.73 m^2	72.27±24.06	76.76±21.99	72.25±23.43	64.39±26.74	48.95±28.20	<0.001
Medications
ACEI or ARB, n (%)	10,776 (51.03)	3863 (50.58)	5257 (51.57)	1572 (50.55)	84 (47.46)	0.389
Beta-blockers, n (%)	17,441 (82.59)	6366 (83.36)	8443 (82.83)	2501 (80.42)	131 (74.01)	<0.001
CCB, n (%)	5003 (23.69)	1963 (25.70)	2382 (23.37)	615 (19.77)	43 (24.29)	<0.001
Statin, n (%)	20,629 (97.69)	7501 (98.22)	9957 (97.68)	3007 (96.69)	164 (92.66)	<0.001

Note: Values are means ± SDs or n (%).

Abbreviations: AMI, acute myocardial infarction; Pre-MI, pre-myocardial infarction; DM, diabetes mellitus; CAD, coronary artery disease; CHF, congestive heart failure; LVEF, left ventricular ejection fraction; WBC, white blood cell; LYM, lymphocyte; eGFR, estimated glomerular filtration rate; ACEI, angiotensin-converting enzyme inhibitors; ARB, angiotensin receptor blockers; CCB, calcium blocker.

Figure 2 Distribution of CONUT scores. A score of 0 to 1 is considered as absent; scores of 2 to 4, 5 to 8, and 9 to 12 reflect mild, moderate, and severe malnutrition, respectively.

Abbreviation: CONUT, Controlling Nutritional Status score.

Table 3 Univariate and Multivariate Cox Proportional Hazards Model for the Association Between Malnutrition and All-Cause Death

	Univariate Analysis		Multivariable Analysis
	HR [95% CI]	p-value	HR [95% CI]	p-value
Continuous CONUT score	1.15 (1.14–1.17)	<0.001	1.06 (1.04–1.08)	<0.001
Malnutrition, degree
Absent	Ref		Ref
Mild	1.46 (1.34–1.59)	<0.001	1.20 (1.09–1.33)	<0.001
Moderate	2.08 (1.88–2.30)	<0.001	1.32 (1.17–1.49)	<0.001
Severe	4.16 (3.31–5.23)	<0.001	1.76 (1.33–2.33)	<0.001
Atrial fibrillation	1.90 (1.62–2.24)	<0.001	1.41 (1.17–1.69)	<0.001
DM	1.29 (1.20–1.39)	<0.001	1.20 (1.10–1.30)	<0.001
eGFR< 60	2.04 (1.89–2.20)	<0.001	1.44 (1.32–1.56)	<0.001
Anemia	1.45 (1.36–1.56)	<0.001	1.12 (1.03–1.21)	0.003
CHF	2.50 (2.28–2.74)	<0.001	1.75 (1.57–1.94)	<0.001
ACEI or ARB	0.81 (0.76–0.88)	<0.001	0.86 (0.80–0.93)	<0.001
Beta-blockers	0.80 (0.73–0.87)	<0.001	0.92 (0.83–1.02)	0.096
Statin	0.58 (0.48–0.70)	<0.001	0.73 (0.60–0.89)	0.002

Notes: Adjusted by gender, age, hypertension, atrial fibrillation, diabetes mellitus, eGFR< 60, chronic kidney disease, anaemia, congestive and heart failure, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, beta-blockers, statin.

Abbreviations: CI, confidence interval; HR, hazard ratio; AMI, acute myocardial infarction; CAD, coronary artery disease; CHF, congestive heart failure; Pre-MI, Pre-myocardial infarction; DM, diabetes mellitus; LVEF, left ventricular ejection fraction; WBC, white blood cell; LYM, lymphocyte; eGFR, estimated glomerular filtration rate; ACEI, angiotensin-converting enzyme inhibitors; ARB, angiotensin receptor blockers; CCB, calcium blocker; CONUT, Controlling Nutritional Status.

Figure 3 Kaplan–Meier curves for all-cause mortality by the CONUT score. A score of 0 to 1 is considered as absent; scores of 2 to 4, 5 to 8, and 9 to 12 reflect mild, moderate, and severe malnutrition, respectively.

Abbreviation: CONUT, Controlling Nutritional Status score.

Figure 4 Forest plots of hazard ratios for the primary endpoint in different subgroups. Adjusted by age, gender, anemia, acute myocardial infarction, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, beta-blockers, chronic kidney disease, congestive heart failure, diabetes mellitus, diabetes mellitus, hypertension, statins, atrial fibrillation.

Abbreviations: DM (-), no diabetes mellitus, DM (+), diabetes mellitus; CHF (-), no congestive heart failure, CHF (+), congestive heart failure; DM, diabetes mellitus; CI, confidence interval; CONUT, Controlling Nutritional Status score.