Prognostic Significance of Malnutrition Indices in ST-Elevation Myocardial Infarction: A Comparative Analysis of CONUT and PNI Scores After Primary PCI

TL;DR

This study compares two malnutrition scores, CONUT and PNI, to predict in-hospital mortality in patients with heart attacks treated with a specific procedure.

Contribution

The study shows that the CONUT score is better than PNI at predicting mortality in STEMI patients after primary PCI.

Findings

In-hospital mortality rate was 5.7% among 4599 STEMI patients.

CONUT score showed better predictive performance than PNI for in-hospital mortality.

Moderate-to-severe malnutrition was observed in 17–21% of patients using CONUT and 8–10% using PNI.

Abstract

Background: The purpose of this study was to compare the prognostic value of Controlling Nutritional Status (CONUT) and Prognostic Nutritional Index (PNI) scores for predicting in-hospital mortality among patients who presented with ST-segment elevation myocardial infarction (STEMI) and received primary percutaneous coronary intervention (P-PCI). Methods: This retrospective cohort study comprised 4599 STEMI patients who received P-PCI. The primary outcome was described as in-hospital mortality. Multivariable logistic regression analysis was performed to determine the association between in-hospital mortality and CONUT and PNI scores. Model performance and goodness-of-fit measures were used for comparison. Results: In-hospital mortality rate was 5.7% (n = 261). Patients who died during the index hospitalization were older and more likely to have diabetes, prior myocardial infarction (MI), revascularization history, longer total ischemic time, no-reflow and reduced left ventricular ejection fraction (LVEF). According to body mass index (BMI) categories, moderate-to-severe malnutrition was observed in approximately 17–21% and 8–10% of patients according to the CONUT and PNI scores, respectively. Both CONUT and PNI scores were significantly associated with in-hospital mortality. However, the model incorporating CONUT demonstrated superior goodness of fit and higher discriminative performance compared with the model incorporating PNI. Conclusions: Among patients with STEMI, moderate-severe malnutrition was present in nearly 10% and 20% when evaluated using PNI and CONUT, respectively. The CONUT score demonstrated superior predictive performance for in-hospital mortality compared with PNI.

Figures