scholarly journals Identification of familial hypercholesterolemia in acute coronary syndrome patients: are we missing the mark?

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
P Garcia Bras ◽  
G Portugal ◽  
A Castelo ◽  
V Ferreira ◽  
J Reis ◽  
...  
Keyword(s):  
Family History ◽  
Familial Hypercholesterolemia ◽  
Cholesterol Level ◽  
Ldl Cholesterol ◽  
Density Lipoprotein ◽  
St Segment Elevation ◽  
St Segment ◽  
All Cause Mortality ◽  
The Mean

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Patients (P) with familial hypercholesterolemia (FH) have considerable elevation in levels of low-density lipoprotein (LDL) cholesterol and a higher risk of premature coronary artery disease (CAD) and acute coronary syndromes (ACS). However, even in a hospital setting with a high volume of ACS P, the diagnosis of FH frequently goes undetected. The aim of this study was to evaluate the application of the Dutch Lipid Clinic Network (DLCN) Criteria in P admitted for ACS and analyse ACS recurrence, hospitalization and mortality in a 30-day follow-up. Methods Retrospective evaluation of P with ACS admitted to a tertiary center from 2005 to 2019. Data from the digital files including family history and laboratory tests was analysed and P were followed up for 30 days for hospitalization, recurrent ACS, all cause mortality and cardiovascular (CV) death. Evaluation of tendinous xanthomata, arcus cornealis and genetic analysis was not undertaken. Results 3811 P were evaluated, mean age 63 ± 13 years, 28% female gender, 1497 P (39%) with active or previous smoking habits, 847 P (22%) with diabetes mellitus, 419 P (11%) with family history of coronary disease, 1340 P (35%) with premature CAD, 53 P (1.4%) with premature cerebral or peripheral vascular disease and 522 (14%) with previous ACS. The mean LDL cholesterol level was 125 ± 43 mg/dL, the mean high-density lipoprotein (HDL) cholesterol level was 40 ± 16 mg/dL and the mean triglyceride level was 132 ± 89 mg/dL. The diagnosis at hospital admission was unstable angina (UA) in 189 P (5%), non-ST-segment elevation myocardial infarction (NSTEMI) in 1024 P (27%) and ST-segment elevation MI (STEMI) in 2598 P (68%). The hospital mortality rate was 4.3% (163P). Applying the DLCN criteria, 3089 P (81%) had a score of <3 ("unlikely FH"), 675 P (17.7%) a score of 3 to 5 ("possible FH"), 41 P (1.1%) a score of 6 to 8 ("probable FH") and 1 P (0.03%) a score of >8 ("definite FH"). Stratifying according to ACS type: among UA, 31 P (16%) had "possible FH" and 4 P (2.1%) had "probable FH". Among NSTEMI, 145 P (14.2%) had "possible FH", 9 P (0.9%) "probable FH" and 1 P (0.03%) had "definite FH". Finally, among STEMI P, 497 P (19.1%) had "possible FH" and 28 P (1.1%) had "probable FH". In a 30-day follow-up, there was an all cause mortality of 2% (78 P) and a CV death of 1.3% (49P), while the all cause hospitalization rate was 3.5% (134P) and the admission rate for recurrent ACS was 1.7% (65P). The DLCN criteria score was significantly correlated with CV death (OR 1.25, CI 95% 1.04-1.50, p = 0.020) and admission for recurrent ACS (OR 1.19, CI 95% 1.04-1.36, p = 0.04). Conclusion Application of the DLCN criteria in P admitted for ACS revealed 675 P (17.7%) with "possible FH" and 41 P (1.1%) with "probable FH" as well as show significant correlation with CV death and recurrent ACS. Routine assessment of these criteria can be an accessible tool to stratify likelihood of FH and proceed accordingly to genetic testing.

Abstract 3330: Effect of Achieved Low-density Lipoprotein Cholesterol Level by Atorvastatin on Stabilization of Coronary Plaques - Results from TWINS study

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Katsuki Okada ◽  
Yasunori Ueda ◽  
Satoshi Saito ◽  
Atsushi Hirayama ◽  
Kazuhisa Kodama
Keyword(s):  
Cholesterol Level ◽  
Ldl Cholesterol ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Coronary Plaque ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Yellow Plaque ◽  
The Mean

Background We have previously reported the stabilization and regression of coronary plaque by atorvastatin using both angioscopy and IVUS. However, it has not been clarified if plaque stabilization is achieved through the reduction of cholesterol level or the direct effect of statin. Then, we analyzed the effect of achieved low-density lipoprotein (LDL) cholesterol level on the stabilization of coronary plaque. Methods Twenty-nine patients with hypercholesterolemia and coronary heart disease were studied. They received lipid-lowering therapy with atorvastatin (10 –20 mg/day) for 80 weeks and were divided into 2 groups by the achieved LDL cholesterol level at 80-week follow up (low LDL group: LDL cholesterol < median value, and high LDL group: LDL cholesterol ≥ median value). Angioscopic examination was performed before and after 80 weeks treatment with atorvastatin. Angioscopic findings of coronary yellow plaque characteristics were divided into six grades (grade 0 to 5) to evaluate vulnerability of plaques; and the mean grade of each patient was evaluated. Results In all 29 patients, LDL cholesterol level was reduced (146.2 to 87.9 mg/dl; p<0.001) and the mean yellow plaque grade was decreased (1.4 to 1.2; p=0.002) at 80-week follow up. LDL cholesterol level was reduced both in low LDL group (140.3 to 75.9 mg/dl; p<0.001) and in high LDL group (151.7 to 99.1 mg/dl; p<0.001). Angioscopic examination showed significant improvement of the grade in low LDL group (1.4 to 1.1; p=0.012) at 80-week follow up, but no significant difference in high LDL group (1.4 to 1.3; p=0.11). Conclusions Lipid-lowering therapy with atorvastatin stabilized coronary plaques, and this effect was larger in the patients LDL cholesterol was reduced more.

Outcomes of nonagenarians with acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Echarte Morales ◽  
P.L Cepas Guillen ◽  
G Caldentey ◽  
E Martinez Gomez ◽  
J Borrego-Rodriguez ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Risk Population ◽  
High Morbidity ◽  
Baseline Characteristic ◽  
Invasive Approach ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
All Cause Mortality

Abstract Background Myocardial infarction (MI) in nonagenarians is associated with high morbidity and mortality. Nonetheless, this population has typically been underrepresented in cardiovascular clinical trials. Objective The aim of this study was to evaluate outcomes of nonagenarian patients presenting with MI who underwent either conservative or invasive management. Methods We retrospectively included all consecutive patients equal to or older than 90yo admitted with non-ST segment elevation (NSTEMI) or ST segment elevation MI (STEMI) in four tertiary care centers between 2005 and 2018. Patients with type 2 myocardial infarction were excluded. We collected patients' baseline characteristic and procedural data. In-hospital and at 1-year follow-up all-cause mortality and major adverse cardiovascular events were assessed. Results 523 patients (mean age 92.6±2 years; 60% females) were analyzed. Overall, 184 patients (35.2%) underwent percutaneous coronary intervention (PCI), increasing over the years, mostly in STEMI group (from 16% of patients in 2005 to 75% in 2018). PCI was preferred in those subjects with less prevalence of disability for activities of daily living (p&lt;0.01). The use of a radial access (76.6%) and bare metal stents (52.7%) was predominant. No significant differences were found in the incidence of major bleeding events or MI-related mechanical complications between both strategies. During index hospitalization, 99 (18.9%) patients died. Whereas no differences were found in the NSTEMI group (p=0.61), a significant lower in-hospital mortality was observed in STEMI group treated with PCI (p&lt;0.01). At one-year follow up, 203 (38.8%) patients died, most of them due to a cardiovascular cause (60.6%). PCI was related to a lower all-cause mortality in either NSTEMI (p&lt;0.01) or STEMI groups (p&lt;0.01) however, lower cardiovascular mortality was only found in STEMI group (p=0.03). Conclusion An invasive approach was performed in over a third of nonagenarian patients, carrying prognostic implications and with a few numbers of complications. PCI seems to be the preferred strategy for STEMI in this high-risk population in spite of age. Figure 1 Funding Acknowledgement Type of funding source: None

Impact of new onset atrial fibrillation on long-term prognosis in patients with acute ST-segment elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.A Baturova ◽  
M.M Demidova ◽  
J Carlson ◽  
D Erlinge ◽  
P.G Platonov
Keyword(s):  
Clinical Characteristics ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
All Cause Mortality ◽  
Long Term Follow Up ◽  
Long Term Prognosis ◽  
New Onset

Abstract Introduction New onset AF is a known complication in patients with acute ST-segment elevation myocardial infarction (STEMI). However, whether new-onset AF affects the long-term prognosis to the same extent as pre-existing AF is not fully clarified and prescription of oral anticoagulants (OAC) in patients with new-onset AF remains a matter of debates. Purpose We aimed to assess the impact of new-onset AF in STEMI patients undergoing primary percutaneous intervention (PCI) on outcome during long-term follow-up in comparison with pre-existing AF and to evaluate effect of OAC therapy in patients with new-onset AF on survival. Methods Study sample comprised of 2277 consecutive patients with STEMI admitted to a tertiary care hospital for primary PCI from 2007 to 2010 (age 66±12 years, 70% male). AF prior to STEMI was documented by record linkage with the Swedish National Patient Register and review of ECGs obtained from the digital archive containing ECGs recorded in the hospital catchment area since 1988. SWEDEHEART registry was used as the source of information regarding clinical characteristics and events during index admission, including new-onset AF and OAC at discharge. All-cause mortality was assessed using the Swedish Cause-of-Death Register 8 years after discharge. Results AF prior to STEMI was documented in 177 patients (8%). Among patients without pre-existing AF (n=2100), new-onset AF was identified in 151 patients (7%). Patients with new-onset AF were older than those without AF history (74±9 vs 65±12 years, p&lt;0.001), but did not differ in regard to other clinical characteristics. Among 2149 STEMI survivors discharged alive, 523 (24%) died during 8 years of follow-up. OAC was prescribed at discharge in 45 (32%) patients with new onset AF and in 49 (31%) patients with pre-existing AF, p=0.901. In a univariate analysis, both new-onset AF (HR 2.18, 95% CI 1.70–2.81, p&lt;0.001) and pre-existing AF (HR 2.80, 95% CI 2.25–3.48, p&lt;0.001) were associated with all-cause mortality, Figure 1. After adjustment for age, gender, cardiac failure, diabetes, BMI and smoking history, new-onset AF remained an independent predictor of all-cause mortality (HR 1.40, 95% CI 1.02–1.92, p=0.037). OAC prescribed at discharge in patients with new-onset AF was not significantly associated with survival (univariate HR 0.86, 95% CI 0.50–1.50, p=0.599). Conclusion New-onset AF developed during hospital admission with STEMI is common and independently predicts all-cause mortality during long-term follow-up after STEMI with risk estimates similar to pre-existing AF. The effect of OAC on survival in patients with new-onset AF is inconclusive as only one third of them received OAC therapy at discharge. Kaplan-Meier survival curve Funding Acknowledgement Type of funding source: None

scholarly journals Circulating Marine and Vegetable Omega-3 at the Time of ST-Segment Elevation Myocardial Infarction and Incident Hard Clinical Endpoints

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1483-1483
Author(s):  
Aleix Sala-Vila ◽  
Iolanda Lázaro-López ◽  
Ferran Rueda ◽  
Germán Cediel ◽  
Antoni Bayés-Genís
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
Hospital Readmission ◽  
Omega 3 ◽  
St Segment Elevation ◽  
Clinical Endpoints ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
All Cause Mortality

Abstract Objectives Dietary marine omega-3 eicosapentaenoic acid (EPA) is readily incorporated into cardiac cell membranes, partially replacing the omega-6 arachidonic acid (AA). Blood omega-3 is an objective marker of their intake over the last days. Increasing blood EPA at the time of a ST-segment elevation myocardial infarction (STEMI) relates to a smaller infarct size and preserved long-term left ventricular ejection fraction. We explored whether blood EPA at the time of STEMI also relates to a lower incidence of hard clinical endpoints. We also explored whether blood alpha-linolenic acid (ALA, the vegetable omega-3) modulates such association. Methods We prospectively included 944 consecutive patients treated with primary percutaneous coronary intervention in a single tertiary referral hospital. We determined fatty acids in serum phosphatidylcholine (PC) at 12 hours of evolution. The primary outcomes were cardiovascular disease-related hospital readmission and all-cause mortality after 3 years of follow-up. We constructed multivariable Cox proportional hazards models, calculating risk estimates as hazard ratios (HR). Results The mean age of the cohort was 61 years and 209 (22.1%) were women. During follow-up, 130 patients (13.8%) were readmitted for cardiovascular disease, and 108 (11.4%) died. After adjustment for known clinical predictors, multivariate analysis showed that EPA in serum PC at the time of STEMI inversely related to incident hospital readmission (HR, 0.74; 95% CI, 0.56–0.96; P = 0.024, for a 1 SD increase). Further adjustment for serum PC AA and ALA did not change the association. EPA in serum PC was found to be unrelated to 3-y total mortality. However, after including serum PC proportions of AA and ALA into the model, we observed a significantly decreased risk of mortality for ALA (HR, 0.65; 95% CI, 0.44–0.96; P = 0.030, for a 1 SD increase). Conclusions Increasing proportions of EPA and ALA in serum PC at the time of STEMI inversely relate to 3-y cardiovascular disease-hospital readmission and all-cause mortality, respectively. Dietary EPA and ALA act synergistically and are partners rather than competitors in improving prognosis in case of a STEMI. Funding Sources Instituto de Salud Carlos III, Spain; California Walnut Commission.

scholarly journals Familial hypercholesterolemia in acute coronary syndrome patients: underdiagnosis in female and in young patients

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
P Garcia Bras ◽  
G Portugal ◽  
A Castelo ◽  
V Ferreira ◽  
R Teixeira ◽  
...  
Keyword(s):  
Familial Hypercholesterolemia ◽  
Age Groups ◽  
Young Patients ◽  
Hospitalization Rate ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Gender And Age ◽  
Tertiary Center ◽  
All Cause Mortality

Abstract Introduction Familial hypercholesterolemia (FH) is often underdiagnosed, particularly in female patients (P), even during hospital admission for acute coronary syndromes (ACS). The aim of this study was to apply the Dutch Lipid Clinic Network (DLCN) Criteria in P admitted for ACS and evaluate gender and age differences. Methods Prospective evaluation of P with ACS admitted to a tertiary center from 2005 to 2019. Data including family history and laboratory tests was analysed for the application of the DLCN criteria and results were stratified according to ACS subtype, gender and age groups (20–39, 40–59, 60–79 and ≥80 years [y]). P were followed up for 30 days for hospitalization, recurring ACS and mortality. Results 3811 P were evaluated, mean age 63±13 years, 28% female and mean LDL cholesterol of 125±43 mg/dL. The admission diagnosis was unstable angina (UA) in 5%, non-ST-segment elevation myocardial infarction (NSTEMI) in 27% and ST-segment elevation MI (STEMI) in 68%. Applying the DLCN criteria, 3089 P (81%) had a score of &lt;3 (unlikely FH), 675P (17.7%) a score of 3 to 5 (possible FH), 41P (1.1%) a score of 6 to 8 (probable FH) and 1P (0.03%) a score of &gt;8 (definite FH). Stratifying according to ACS type: among UA, 31P (16%) had possible FH and 4P (2.1%) had probable FH. Among NSTEMI, 145P (14.2%) had possible FH, 9P (0.9%) probable FH and 1P (0.03%) definite FH. Finally, among STEMI P, 497P (19.1%) had possible FH and 28P (1.1%) probable FH. Regarding female P, 158P (14.7%) had possible FH and 16 P (1.5%) probable FH. Among male P, 517P (18.9%) had possible FH and 25P (0.9%) probable FH (p=0.016 for interaction). According to age groups, among P aged 20–39 y (136P), 61P (44.9%) had possible FH and 6P (4.4%) had probable FH. Concerning P aged 40–59 y (1766P), 575P (32.6%) had possible FH, 31 P (1.8%) probable FH and 1P (0.1%) definite FH. With regard to P aged 60–80 y (2122P), 80P (3.8%) had possible FH and 4P (0.2%) probable FH. Among P aged ≥80 y (1837P), only 9P (0.5%) had possible FH and no P had probable FH. In a 30-day follow-up, there was an hospitalization rate of 3.5% (134P) and recurring ACS in 1.7% (65P), while the all-cause mortality was 2% (78P) and cardiovascular (CV) death was 1.3% (49P). Female P had a significantly lower hospitalization rate (1.8% vs 3.2%, p=0.003) as well as fewer recurring ACS (0.6% vs 1.7%, p=0.001). There was no significant gender difference regarding all-cause mortality (female 1.7% vs 1.5%, p=0.552) or CV death (0.8% vs 1.1%, p=0.323). The DLCN criteria score was significantly correlated with admission for recurring ACS (OR 1.19 [95% CI 1.04–1.36], p=0.04). Conclusion Application of the DLCN criteria in female P admitted for ACS revealed 158P (14.7%) with possible FH and 16P (1.5%) with probable FH. Regarding younger ACS P (20–39y), 44.9% had criteria for possible FH and 4.4% for probable FH, prompting us to do not overlook these P subgroups in daily practice and routinely assess the likelihood of FH. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Myocardial Work and long-term prognosis in patients after ST-segment elevation acute myocardial infarction

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Timoteo ◽  
L Moura Branco ◽  
A Galrinho ◽  
T Mano ◽  
P Rio ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Global Longitudinal Strain ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
All Cause Mortality ◽  
Elevation Acute Myocardial Infarction

Abstract Background Left ventricular (LV) global longitudinal strain has demonstrated incremental prognostic value over LV ejection fraction (LVEF) in patients with ST-segment-elevation acute myocardial infarction. However, LV global longitudinal strain (GLS) does not take into consideration the effect of afterload. Myocardial work (MW) by speckle-tracking echocardiography integrates blood pressure measurements (afterload) with LV GLS and it has been recently demonstrated that Global Work Efficiency (GWE) is associated with long-term all-cause mortality. It remains to be demonstrated if MW indices are associated with hard cardiovascular endpoints. The present study aimed to investigate the prognostic value of global LV MW obtained from pressure-strain loops with echocardiography in patients with ST-segment-elevation myocardial infarction. Methods A total of 100 consecutive ST-segment-elevation myocardial infarction patients (mean age, 61±12 years; 75% men) that survived to discharge were retrospectively analysed. LVEF, GLS and all LVMW indices were measured by transthoracic echocardiography before discharge (4.6±2.0 days after admission). All patients had at least a two-year follow-up (mean follow-up of 833±172 days). Outcomes: all-cause mortality, major acute cardiovascular events (a composite of cardiovascular mortality, myocardial infarction, stroke, unplanned cardiovascular admission) and heart failure hospitalization. Results In the two-year follow-up, 6 patients died, there were 17 patients with MACE, and 3 patients were hospitalized with heart failure. We confirmed that for all-cause mortality, GWE showed higher discrimination, compared to GLS (Table 1), with a cut-off of 83% (log-rank &lt;0,001). For MACE, the performance of all methods is suboptimal, with an AUC &lt;0.65 for all variables, except for GLS. For heart failure admission, performance is slightly better, but GLS is still the better parameter to predict this event. Conclusions LVGWE is a better predictor of all-cause mortality compared to GLS, but MW indices failed to demonstrate a prognostic impact in long-term cardiovascular events. Prospective studies are warranted to confirm this finding. FUNDunding Acknowledgement Type of funding sources: None. Table 1

scholarly journals MYOCARDIAL INFARCTION;

2019 ◽  
Vol 26 (01) ◽  
Author(s):  
Muhammad Farrukh Bhatti ◽  
Muhammad Abu Bakar Afzal ◽  
Ansar Latif ◽  
Zeeshan Hassan ◽  
Sharoon Shahzad
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Risk Factor ◽  
Family History ◽  
Teaching Hospital ◽  
Medical Advice ◽  
St Segment Elevation ◽  
St Segment ◽  
Males And Females

Objectives: The study was carried out to asserting the prevalence and comparative analysis of risk factor that are known to be associated with ST-segment elevation MI on the basis of genderin Emergency unit of cardiology department of Allama Iqbal Memorial Teaching Hospital, Sialkot. Study Design: Retrospective, observational study. Place and duration of Study: Department of Cardiology; Allama Iqbal Memorial Teaching Hospital, Sialkot. From 1st March 2017 till 28 Feb 2018. Patients and Methods: All patients presented in cardic emergency during specified time period at Allama Iqbal Memorial Teaching Hospital with new onset of ST segment elevation MI, having established risk factors (DM, Smoking, Family History of IHD, Obesity, Dyslipidemia) having completed follow up of 2 months were included in study. Patients were assigned in two group according to their respective gender for finding out prevalence of risk factors among them. Group-I included males while Group-II included females.Patients who didn’t completed followup, not willing to participate in study, who leave against medical advice, had CCF, CRF, CLD, LBBB, Coagulation abnormalities, stroke, any condition mimicking ST segment elevation other than STEMI were excluded from study. The data collected for variables was analyzed using SPSS v 22. Results: Three hundred and fifty (350) patients presented in cardic emergency were subjected to the study. Out of 350, 20 patients didn’t complete the follow-up of 2 months. Ten patients didn’t give consent to be included in the study while 15 patients were excluded in accordance with the exclusion criteria and 5 patients were left against medical advice. Out of 300 patients studied 233 of patients (77.7%) were males and 67(22.3%) of patients were female, with male to female ratio of 3.5:1.0. Among age group variation patients in range of 41-50 years constitute 40.3% (121 patients) of cases. Smoking as a risk factor constitute 70.4%(164 pt.) and Diabetes mellitus 62.3% (43pt.) among males and females respectively. Anterior wall MI reports to be 62.20%(145 pt.) and 82.10%(55 pt.) among males and females followed by other types of STEMI. Conclusion: Smoking is identified as an independent risk factor that can lead to STEMI in young males while Diabetes Mellitus and hypertension identified as a risk factor for progression to STEMI in females. Among non-modifiable factors male sex, old adults and family history identified as factors that can lead to STEMI.

Geriatric nutritional risk index is a predictor of recurrent percutaneous coronary intervention in patients with non-ST segment elevation myocardial infarction

Kardiologiia ◽  
2021 ◽  
Vol 61 (8) ◽  
pp. 60-67
Author(s):  
Mehmet Kaplan ◽  
Ertan Vuruskan ◽  
Gökhan Altunbas ◽  
Fethi Yavuz ◽  
Gizem Ilgın Kaplan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Risk Group ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary ◽  
All Cause Mortality

Aim To investigate the relationship between malnutrition and follow-up cardiovascular (CV) events in non-ST-segment elevation myocardial infarction (NSTEMI).Material and methods A retrospective study was performed on 298 patients with NSTEMI. The baseline geriatric nutritionalrisk index (GNRI) was calculated at the first visit. The patients were divided into three groups accordingto the GNRI: >98, no-risk; 92 to ≤98, low risk; 82 to <92, moderate to high (MTH) risk. The studyendpoint was a composite of follow-up CV events, including all-cause mortality, non-valvular atrialfibrillation (NVAF), hospitalizations, and need for repeat percutaneous coronary intervention (PCI).Results Follow-up data showed that MTH risk group had significantly higher incidence of repeat PCI and all-cause mortality compared to other groups (p<0.001). However, follow-up hospitalizations and NVAFwere similar between groups (p>0.05). The mean GNRI was 84.6 in patients needing repeat PCI and99.8 in patients who did not require repeat PCI (p<0.001). Kaplan Meier survival analysis showed thatpatients with MTH risk had significantly poorer survival (p<0.001). According to multivariate Coxregression analysis, theMTH risk group (hazard ratio=5.372) was associated with increased mortality.Conclusion GNRI value may have a potential role for the prediction of repeat PCI in patients with NSTEMI.

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