American heart journal · 2026
Impact of malnutrition on outcomes among elderly ST-Elevation myocardial infarction patients receiving primary percutaneous coronary intervention.
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Hosseini Farshad, Kang Mehima, Segal Tori, Singer Joel, Lee Terry, Madden Kenneth, Cairns John A, Wong Graham C, Fordyce Christopher B
Аннотация
BACKGROUND: While malnutrition has been shown to confer a poor long-term prognosis among patients with acute coronary syndromes, the influence of concomitant frailty has not been adequately considered. We aimed to evaluate the association between malnutrition severity and both in-hospital and 1-year outcomes among elderly STEMI patients receiving primary PCI.
METHODS: This retrospective cohort study included STEMI patients ≥65 years who underwent primary PCI within the Vancouver Coastal Health Authority (2007-2020). Malnutrition was assessed using the Controlling Nutritional Status (CONUT) score based on serum albumin, total cholesterol, and lymphocyte count; scores 5-12 defined malnourishment. Frailty was quantified using a 31-item Frailty Index (FI) and modeled continuously in multivariable analyses. The primary outcome was in-hospital all-cause mortality. Secondary outcomes were a composite of adverse in-hospital events and 1-year all-cause mortality.
RESULTS: Among 1,169 included patients, 315 (26.9%) were malnourished. After adjustment for age, sex, FI, and clinical covariates, increasing CONUT score (per 3-point increase) remained associated with in-hospital mortality (OR, 2.83; 95% CI, 2.01-3.97), composite in-hospital adverse outcomes (OR, 1.41; 95% CI, 1.12-1.77), and 1-year all-cause mortality (OR, 2.16; 95% CI, 1.41-3.31). Associations persisted after excluding frailty from the model.
CONCLUSION: Approximately one in four elderly STEMI patients undergoing primary PCI were malnourished. Worsening malnutrition was associated with adverse in-hospital and 1-year outcomes, even after adjusting for frailty. Routine screening for malnutrition may help identify higher-risk patients and facilitate early risk stratification and targeted nutritional and rehabilitative interventions in STEMI care.
METHODS: This retrospective cohort study included STEMI patients ≥65 years who underwent primary PCI within the Vancouver Coastal Health Authority (2007-2020). Malnutrition was assessed using the Controlling Nutritional Status (CONUT) score based on serum albumin, total cholesterol, and lymphocyte count; scores 5-12 defined malnourishment. Frailty was quantified using a 31-item Frailty Index (FI) and modeled continuously in multivariable analyses. The primary outcome was in-hospital all-cause mortality. Secondary outcomes were a composite of adverse in-hospital events and 1-year all-cause mortality.
RESULTS: Among 1,169 included patients, 315 (26.9%) were malnourished. After adjustment for age, sex, FI, and clinical covariates, increasing CONUT score (per 3-point increase) remained associated with in-hospital mortality (OR, 2.83; 95% CI, 2.01-3.97), composite in-hospital adverse outcomes (OR, 1.41; 95% CI, 1.12-1.77), and 1-year all-cause mortality (OR, 2.16; 95% CI, 1.41-3.31). Associations persisted after excluding frailty from the model.
CONCLUSION: Approximately one in four elderly STEMI patients undergoing primary PCI were malnourished. Worsening malnutrition was associated with adverse in-hospital and 1-year outcomes, even after adjusting for frailty. Routine screening for malnutrition may help identify higher-risk patients and facilitate early risk stratification and targeted nutritional and rehabilitative interventions in STEMI care.