Altered nutritional status, inflammation and systemic vulnerability in patients with acute myocardial infarction undergoing percutaneous coronary revascularization – a prospective study in a level 3 cardiac critical care unit

Introduction: While the impact of nutritional status and inflammation on the early outcome of subjects with acute myocardial infarction (AMI) has been well do-cumented, the role of the complex interaction between these three risk factors it is not fully elucidated.
Objective: To assess the link between poor nutritional status, as expressed by CONUT and GNRI index, and inflammatory response following an acute myocardial infarction.
Methods: T his is an observational prospective study which included 86 consecutive patients with AMI who underwent primary percutaneous intervention of the infarct-related artery in emergency. Nutritional sta-tus assessment was based on the calculation of CO-NUT and GNRI scores. The 86 patients included in the analysis were divided into two groups according to CONUT score: group 1 – normal or mild risk (CONUT <3) and group 2 – moderate-to-severe risk (CONUT ≥3).
Results: Group distribution was: group 1 – 79.06% (n=68), group 2 – 20.93% (n=18). Patients with poor nutritional status were significantly older (67.1 +/-11.4 years of age vs. 59.8 +/- 13.7, p<0.042), and presented more frequent previous angina pectoris in their recent history (50.0% vs. 17.6%, p=0.005). There were no sig-nificant differences between the two groups regarding smoking status (p=0.2), hypertension (p=0.2), diabetes (p=0.4), dyslipidemia (p=0.4), or previous myocardi-al infarction (p=0.1). Serum albumin level and GNRI score was significantly lower in group 2 (p<0.0001), similarly to total cholesterol levels (p=0.004) when compared with group 1. Inflammatory status assess-ment showed that both, baseline serum levels and after 7 days serum levels of hs-CRP were significantly higher in the group with high CONUT score (baseline: 33.6 +/- 35.02 mg/dl vs. 10.26 +/- 25.93 mg/dl, p<0.0001) respectively (7 days: 52.8 +/- 46.25 mg/dl vs. 17.04 +/-24.78 mg/dl, p<0.0001). Haematological parameters analysis showed that patients with poor nutritional sta-tus had significantly higher numbers of thrombocytes (394.049 vs. 241.019, p=0.002). The amount of white blood cells and total red blood cells did not differ signi-ficantly between the groups, however patients with sco-re CONUT ≥3 presented significantly higher number of neutrophils (p=0.005), and significantly lower num-bers of lymphocytes (p<0.0001) as compared to those who had CONUT <3.
Conclusions: This study showed that poor nutritional status can lead to an increased inflammatory response, high haemodynamic instability and a more pronoun-ced pro-coagulant status in patients with acute myo-cardial infarction, and also an unfavorable short-term prognosis.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)