The Predictive Value of Geriatric Nutritional Risk Index Combined with the GRACE Score in Predicting the Risk of One Year Poor Prognosis in Elderly Patients with Non-ST Segment Elevation Myocardial Infarction After PCI

Abstract

Background

As a nutritional indicator, a lower level of geriatric nutritional risk index (GNRI) has been suggested as a predictor for poor prognosis in acute coronary syndrome (ACS). However, whether GNRI could improve the predictive value of the Global Registry of Acute Coronary Events (GRACE) score for the prognosis in elderly patients with non-ST segment elevation myocardial infarction (NSTEMI) after PCI remains unclear.

Methods

A total of 446 elderly patients with NSTEMI after percutaneous coronary intervention (PCI) were consecutively enrolled. Patients were divided into major adverse cardiovascular and cerebrovascular events (MACCE) group and control group according to the occurrence of MACCE during one year follow up. The clinical parameters including GNRI were compared to investigate the predictors for MACCE. The performance after the addition of GNRI to the GRACE score for predicting MACCE was determined.

Results

A total of 68 patients developed MACCE. In unadjusted analyses, the rate of MACCE was significantly higher in the 93.8<GNRI <102.7 group and GNRI ≤ 93.8 group versus GNRI ≥ 102.7 group. The logistics regression model showed that age, GNRI, and GRACE score were independent predictors for MACCE in elderly patients with NSTEMI after PCI. The addition of the GNRI to the GRACE score significantly improved the prediction of MACCE in elderly patients with NSTEMI after PCI, increasing the C-index from 0.792 to 0.885 (p < 0.001); the NRI was 0.094 (95% CI, 0.004–0.177, p < 0.001), and the IDI was 0.011 (95% CI, 0.000–0.023, p < 0.001).

Conclusion

Combining GNRI and GRACE score could significantly improve the predictive value of one year MACCE in elderly patients with NSTEMI after PCI. By using this combined new risk model, we could easily identify the high-risk populations in clinical practice, so as to better monitor and manage them.