Nutritional status and all-cause mortality in older adults with acute coronary syndrome. Issue 5 (May 2020)

• Record Type: Journal Article
• Authors: Tonet, Elisabetta; Campo, Gianluca; Maietti, Elisa; Formiga, Francesc; Martinez-Sellés, Manuel; Pavasini, Rita; Biscaglia, Simone; Serenelli, Matteo; Sanchis, Juan; Diez-Villanueva, Pablo; Bugani, Giulia; Vitali, Francesco; Ruggiero, Rossella; Cimaglia, Paolo; Bernucci, Davide; Volpato, Stefano; Ferrari, Roberto; Ariza-Solé, Albert
• Is Part Of: Clinical nutrition. Volume 39:Issue 5(2020)
• Page Start: 1572
• Page End: 1579
• Publication Date: 2020-05
• Subjects: Acute coronary syndrome -- Nutrition -- Elderly -- Mortality; ACS acute coronary syndrome -- GRACE score Global Registry of Acute Coronary Events score -- FRASER frailty in elderly patients receiving cardiac interventional procedures -- LONGEVO-SCA impacto de la fragilidad y otros síndromes geriátricos en el manejo y pronóstico vital del anciano con síndrome coronario agudo sin elevación de segmento ST -- MI myocardial infarction -- MNA-SF mini-nutritional short form -- SPPB short physical performance battery -- STEMI ST-segment elevation myocardial infarction; Critically ill -- Nutrition -- Periodicals; Diet therapy -- Periodicals; Parenteral feeding -- Periodicals; Enteral feeding -- Periodicals; Enteral Nutrition -- Periodicals; Parenteral Nutrition -- Periodicals; Metabolism -- Periodicals; Diétothérapie -- Périodiques; Alimentation parentérale -- Périodiques; Alimentation entérale -- Périodiques; Nutrition -- Périodiques; Diet therapy; Enteral feeding; Nutrition; Parenteral feeding; Electronic journals; Periodicals; Electronic journals; 615.854
• DOI: 10.1016/j.clnu.2019.06.025
• Languages: English
• ISSNs: 0261-5614

Abstract

Summary: Background & aims: The present analysis investigated the prevalence and the prognostic implication of nutritional status in older adults hospitalized for acute coronary syndrome (ACS). Methods: The analysis is based on older ACS patients included in the FRASER and LONGEVO SCA studies. The Global Risk of Acute Coronary Events (GRACE) risk score was computed in all patients. Nutritional status was assessed with the Mini Nutritional Assessment-Short Form (MNA-SF, normal for values between 12 and 14, at risk of malnutrition for values between 8 and 11, and malnutrition for values ≤ 7). Physical performance was assessed with the Short Physical Performance Battery (SPPB). Primary outcome was all-cause mortality. Results: The study included 908 patients. Overall, 35 patients (4%) were malnourished and 361 (40%) were at risk of malnutrition. After a median follow-up of 288 [187–370] days, the primary endpoint occurred in 94 (10.5%) patients. The mortality rate was 31% in malnourished subjects, 19% in at- risk patients, 3% in patients with a normal nutritional status (p < 0.001). MNA-SF emerged as an independent predictor of all-cause mortality (HR 0.76, 95%CI 0.68–0.84 for single change unit). The MNA-SF score improved the GRACE score's ability to discriminate subjects at risk of death (ΔC-statistic = 0.076, p < 0.001; ΔBIC -28; IDI 0.052, p < 0.001; NRI 0.793, p < 0.001). The prognostic value of MNA-SF was maintained also by including the SPPB score in the predictive model. Conclusion: s: The MNA-SF helped to identify malnutrition in older ACS patients. Moreover, the MNA-SF value is an independent predictor of all-cause mortality and it improves the predictive value of the GRACE risk score.