Clinical study of a new nutritional index for predicting long-term prognosis in patients with coronary atherosclerotic heart disease following percutaneous coronary intervention

Xinqiu Chu; Yuewen Yuan; Jiya Chen; Yanwei Yu; Yang Li

doi:10.1515/fzm-2024-0016

Clinical study of a new nutritional index for predicting long-term prognosis in patients with coronary atherosclerotic heart disease following percutaneous coronary intervention

doi: 10.1515/fzm-2024-0016

Xinqiu Chu^{1, 2},
Yuewen Yuan¹,
Jiya Chen¹,
Yanwei Yu¹,
Yang Li^{1
, ,}

1.
Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University
2.
The Second Affiliated Hospital of Dalian Mediacal University

Funds:

The outstanding young teachers basic research support program of Heilongjiang Provincial Department of Education YQJH2023050

More Information

Corresponding author: Yang Li, E-mail: doctor_yangli@aliyun.com

摘要

Abstract: Background and Objective Some patients continue to experience major adverse cardiovascular and cerebrovascular events (MACCE) after percutaneous coronary intervention (PCI) in frigid places. Indexes of inflammation and nutrition alone were shown to predict outcomes in patients with PCI. However, the clinical predictive value of mixed indicators is unclear. This study aimed to assess the predictive value of the albumin/neutrophil/lymphocyte ratio (NLR) on the long-term prognosis of patients with coronary heart disease (CHD) following percutaneous coronary intervention (PCI). Methods A total of 608 post-PCI CHD patients were categorized into low- and high-index groups based on the optimal cut-off values for albumin and NLR. The primary outcome was a composite endpoint comprising all-cause mortality and major adverse cerebrovascular events. The secondary outcome was the comparison of the predictive efficiency of the new nutritional index, albumin/NLR, with that of albumin or NLR alone. Results Over the five-year follow-up period, 45 patients experienced the composite endpoint. The incidence of endpoint events was significantly higher in the low-index group (12%) compared to the high-index group (4.9%). Receiver operating characteristic (ROC) curve analysis revealed that the albumin/NLR index had a larger area under the curve (AUC: 0.655) than albumin (AUC: 0.621) or NLR (AUC: 0.646), indicating superior predictive efficiency. The prognostic nutritional index had an AUC of 0.644, further supporting the enhanced predictive value of the albumin/NLR index over individual nutritional and inflammatory markers. Conclusion The albumin/neutrophil/lymphocyte ratio is independently associated with the long-term prognosis of CHD patients post-PCI and demonstrates superior predictive efficiency compared to individual nutritional and inflammatory markers.
- coronary heart disease /
- percutaneous coronary intervention /
- malnutrition /
- inflammation /
- cardiovascular prognosis
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Figure 1. Receiver operating characteristic (ROC) curve of the new nutritional index

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Figure 2. Kaplan–Meier and cumulative hazard curves.

(A) The Kaplan–Meier curve displays survival time (in months) on the horizontal axis and the cumulative survival rate on the vertical axis. (B) The cumulative risk curve shows time to event (in months) on the horizontal axis and the cumulative incidence of all-cause mortality and major adverse cardiovascular and cerebrovascular events (MACCE) on the vertical axis. Log-rank analysis indicates a significant difference (P = 0.001).

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Table 1. Comparison of general characteristics between the low- and high-index groups

Characteristics	Total (N = 608)	Low-index group (N = 217)	High-index group (N = 391)	P-value
Age, years	59.50 (52.25, 66.00)	61.00 (55.00, 69.00)	58.00 (52.00, 65.00)	< 0.001
Sex
Male	406 (66.8)	147 (67.7)	259 (66.2)	0.706
Female	202 (33.2)	70 (32.3)	132 (33.8)	0.294
Smokingx
Yes	235 (38.7)	88 (40.6)	147 (37.6)	0.473
No	373 (61.3)	129 (59.4)	244 (62.4)	0.527
Other comorbiditiesx
Hypertension	343 (56.4)	117 (53.9)	226 (57.8)	0.355
Diabetes mellitus	158 (26.0)	59 (27.2)	99 (25.3)	0.615
Heart failure	60 (9.9)	43 (19.8)	17 (4.3)	< 0.001
Stroke	117 (19.2)	45 (20.7)	72 (18.4)	0.486
Myocardial infarction	45 (7.4)	17 (7.8)	28 (7.2)	0.761
Drug usex
ACEI/ARB	221 (36.3)	88 (40.6)	133 (34.0)	0.108
Beta receptor antagonist	336 (55.3)	128 (59.0)	208 (53.2)	0.169
CCB	203 (33.4)	59 (27.2)	144 (36.8)	0.016
Values are presented as number (%), unless otherwise stated; ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin II receptor antagonist; CCB, calcium channel blocker.

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Table 2. Comparison of routine laboratory indices and left ventricular ejection fraction (LVEF) between the low- and high-index groups

Characteristics	Total (N = 608)	Low-index group (N = 217)	High-index group (N = 391)	P-value
Laboratory parameters
Triglycerides	1.60 (1.21, 2.30)	1.51 (1.18, 2.03)	1.67 (1.25, 2.50)	0.004
Total cholesterol	4.51 (3.81, 5.31)	4.50 (3.86, 5.17)	4.53 (3.80, 5.36)	0.320
LDL	2.72 (2.16, 3.30)	2.75 (2.18, 3.28)	2.72 (2.16, 3.30)	0.728
HDL	1.07 (0.94, 1.26)	1.04 (0.92, 1.22)	1.09 (0.95, 1.26)	0.058
Trioxypurine	343.45 (288.75, 404.75)	348.20 (289.30, 406.60)	341.60 (288.60, 403.00)	0.726
GFR	91.72 (79.15, 105.93)	92.23 (75.22, 108.01)	91.27 (80.19, 105.48)	0.790
Serum albumin	43.78 ± 3.42	42.24 ± 3.59	44.63 ± 3.00	< 0.001
Neutrophil count	4.07 (3.21, 5.18)	5.34 (4.28, 6.44)	3.57 (2.93, 4.36)	< 0.001
Lymphocyte count	1.95 (1.55, 2.40)	1.51 (1.18, 1.85)	2.19 (1.79, 2.59)	< 0.001
Healthy nutritional status
BMI	25.35 (23.18, 27.46)	25.18 (22.55, 27.55)	25.35 (23.44, 27.43)	0.351
Imageological examination
LVEF, %	59.00 (57.00, 60.00)	58.00 (56.00, 60.00)	59.00 (58.00, 60.00)	< 0.001
LVEF, left ventricular ejection fraction; LDL, low-density lipoprotein; HDL, high-density lipoprotein; GFR, glomerular filtration rate; BMI, body mass index.

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Table 3. Cox proportional hazards regression analysis for all-cause mortality and MACCE

Variables	Single-factor analysis			Multiple-factor analysis
	HR	95% CI	P-value	HR	95% CI	P-value
Age	1.509	1.026-1.094	< 0.001	1.038	1.003-1.074	0.033
Hypertension	0.512	0.269-0.976	0.042	0.662	0.326-1.345	0.254
Heart failure	2.375	1.144-4.930	0.020	1.092	0.405-2.942	0.862
Myocardial infarction	0.265	0.131-0.535	< 0.001	0.415	0.179-0.961	0.040
ACEI/ARB	0.364	0.201-0.661	0.001	0.531	0.275-1.026	0.059
GFR	0.974	0.960-0.988	< 0.001	0.988	0.973-1.002	0.091
LVEF	0.932	0.894-0.971	0.001	0.977	0.922-1.036	0.433
Low-index group	2.584	1.430-4.670	0.002	2.179	1.163-4.080	0.015
MACCE, major unconscionable cerebrovascular events; HR, hazard ratio; CI, confidence interval; ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin II receptor antagonist; GFR, glomerular filtration rate; LVEF, left ventricular ejection fraction.

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