Association between prognostic nutritional index and the clinical outcomes of patients with acute myocardial infarction: a systematic review and meta-analysis

TL;DR

This study finds that higher nutritional index scores are linked to lower mortality in patients with heart attacks, but not to major cardiovascular events.

Contribution

The study provides a meta-analysis confirming the prognostic value of the PNI in predicting mortality in acute myocardial infarction patients.

Findings

Higher PNI values correlate with reduced mortality in acute myocardial infarction patients (HR = 0.91).

No significant association was found between PNI and major adverse cardiovascular events (MACE).

Sensitivity and subgroup analyses confirmed the stability of the mortality findings.

Abstract

Emerging data suggest a correlation between the prognostic nutritional index (PNI) and the clinical outcomes of patients with acute myocardial infarction. Despite these findings, the overall conclusions remain inconclusive.

A comprehensive literature search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library, covering the period to October 31, 2024, Examining the relationship between PNI and clinical outcomes in AMI patients. The outcomes included mortality due to acute myocardial infarction, major adverse cardiovascular events (MACE), in-hospital mortality, and acute kidney injury. These outcomes were using hazard ratios (HR) and corresponding 95% confidence intervals (CI). Sensitivity and subgroup analysis were used to assess the stability of the results and potential sources of heterogeneity. All analyses were performed using Review Manager 5.4 and STATA 15.0.

Our analysis included twelve retrospective cohort studies and two prospective studies. Demonstrated a correlation between PNI values and mortality (HR = 0.91, 95% CI: 0.91–0.85; p < 0.0001). No significant association between the PNI and the incidence of MACE in patients with AMI (HR = 0.85, 95% CI: 0.66–1.11; p = 0.23). Sensitivity and subgroup analysis confirmed the stability of the results.

PNI has a strong link to lower mortality rates in patients with AMI, higher the PNI values correspond to lower mortality risk. No significant relationship between PNI and MACE was observed. PNI could be an important factor in individualized managenent of AMI patients in clinical settings.

PROSPERO, identifier CRD42024620983.

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