Physicians' Academy for Cardiovascular Education

Malnutrition in ACS patients associated with increased risk of mortality and MACE

Prevalence and Prognostic Significance of Malnutrition in Patients With Acute Coronary Syndrome

Literature - Raposeiras Roubín S, Abu Assi E, Cespón Fernandez M et al. - J Am Coll Cardiol 2020;76:828–40,

Introduction and methods

It has been demonstrated that malnutrition is associated with CVD in studies focusing on patients with heart failure, valvular heart disease or atrial fibrillation [1-3]. In patients with ACS, it is unsure what the association between malnutrition, CV events and mortality is. Therefore, in this study the prevalence, clinical associations and prognostic consequences of malnutrition were investigated in a contemporary cohort of ACS patients.

This retrospective, observational study used data from the Registry of Acute Coronary Syndrome From University Hospital of Vigo (CardioCHUVI), and enrolled 5062 ACS patients admitted

between January 2010 and September 2017 to the University Hospital Álvaro Cunqueiro, Vigo, Spain. Malnutrition was screened using 3 indexes: the Controlling Nutritional Status score (CONUT) [4], the Nutritional Risk Index (NRI) [5], the Prognostic Nutritional Index score (PNI) [6]. ]. CONUT takes into account serum albumin, cholesterol and total lymphocyte count. NRI is calculated as follows: 1.519 x serum albumin + 41.7 x (current body weight/ideal body weight). PNI is calculated as follows: 10 x serum albumin + 0.005 x total lymphocyte count. The primary endpoint was all-cause mortality. The secondary endpoint was the composite of major CV events (MACEs), including CV death, reinfarction, or ischemic stroke. Median follow-up was 3.6 years (IQR: 1.3-5.3 years).

Main results


In a contemporary cohort of ACS patients in Spain, malnutrition determined by 3 different scores was common. Malnutrition was associated with increased risk of mortality and MACE for all 3 malnutrition indexes used. Assessment of malnutrition could help to identify patients with increased risk of mortality and MACEs and who need nutritional support to improve outcomes.


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