Prognostic stratification using the clinical frailty scale and geriatric nutritional risk index in patients after percutaneous coronary intervention: Sub-analysis of the SAKURA PCI2 antithrombotic registry.

Abstract

Background: Although clinical frailty and nutritional status are associated with adverse events in patients after percutaneous coronary intervention (PCI), those two factors are closely interrelated. This study evaluated the prognostic utility of the Geriatric Nutritional Risk Index (GNRI), a nutritional risk assessment tool, in stratifying outcomes in patients with and without frailty.

Methods: We used data from a prospective multicenter registry (SAKURA PCI2 Antithrombotic Registry) from June 2020 until September 2022. This study included 973 patients who underwent PCI [age: 72 (61, 79) years] and had available data. The patients were stratified into four groups based on the Clinical Frailty Scale (CFS) scores (CFS ≥4 defined as vulnerable frailty) and GNRI values (GNRI <92 defined as a high nutritional risk).

Results: Of the total patients, 67 (6.9 %) had vulnerable frailty and GNRI <92, 115 (11.8 %) vulnerable frailty and GNRI ≥92, 98 (10.1 %) non-frailty and GNRI <92, and 693 (71.2 %) non-frailty and GNRI ≥92. During a median follow-up of 737 (565-956) days, a Kaplan-Meier curve revealed that patients with a GNRI <92 had higher rates of composite adverse events, including all-cause death, non-fatal myocardial infarctions, stent thromboses, hospitalizations for heart failure, Bleeding Academic Research Consortium 3 or 5 bleeding events, strokes, and venous thromboembolisms, regardless of the frailty status (log-rank, p < 0.05 for both). After adjusting for potential confounding factors, the vulnerable frailty group with a GNRI <92 had the highest composite adverse event rates, with a hazard ratio of 2.51 (95 % confidence interval 1.59-3.95, p < 0.001) compared to the non-frailty group with a GNRI ≥92.

Conclusions: Both frailty and malnutrition were significantly linked to adverse outcomes in post-PCI patients, with malnutrition exerting an influence regardless of the frailty status. The GNRI, in particular, served as a valuable prognostic tool, enhancing the risk stratification among frail patients following PCI.