Correlation Study Between CONUT And Prognosis In Patients With ST-elevation Myocardial Infarction Complicated By Congestive Heart Failure

Objective The prognosis of Acute myocardial infarction(AMI)and heart failure(HF)has improved dramatically yet STEMI complicated by HF still carries a p oor prognosis worldwide.Currently,there were few study in these patients.The o bjective of the study is to investigate the correlation between objective nutritio nal indice such as controlling nutritional status(CONUT)score and long-term pr ognosis in these special patients,and then to identify and treat these patients in early stage in order to improve prognosis.Methods We performed a monocentric retrospective cohort study in patients with STEMI complicated by heart failure.we consecutively enrolled 323 cases beteween January 2014 and December 2017 at Fujian Provincial Hospital.The endpoint of the study was long-term mortality of all cause.The median follow-up time was 30 months.All cases were divided into three categories according to CONUT scores:normal group(CONUT 0-1,n=98),mild malnourished group(CONUT 2-4,n=163)and morderate-severe malnourished group(CONUT≥5,n=62).The univariate and multivariate COX regression analysis were used to reveal the correlation of nutritional states and long-term mortality.The Kaplan–Meier survival curve analysis was conducted to compare the prognosis of the different tertiles of CONUT.Time-dependent receiver operating characteristic(ROC)analysis was generated to investigate the prognostic or predictive accuracy.Results A total of 323 patients were selected in this study and 225 cases were malnourished in which mild malnutrition were 163 patients and morderate-sever e malnutrition were 62.There were 53(16.4%)patients died for all cause of dea th,during a median follow-up period of 30 months.The univariate COX regressi on analysis revealed that when CONUT score as a continuous variable,higher CONUT scores were significantly correlated with increased risk of mortality(Ha zard Ratio:1.32,95%Confidence interval:1.21-1.46,p<0.001).In multivariate Cox re gression analysis after adjusting for relevant factors,CONUT score as a continu ous variable,a per point increase in the CONUT score was associated with incr eased risk of all-cause death(Hazard Ratio:1.21,95%Confidence interval:1.09-1.35,p=0.001).When CONUT score used as a categorical variable,univariate COX r egression analysis showed that the all-cause mortality in Tertile 3(CONUT≥5)was significantly higher than that in Tertile 1(CONUT=0-1)(Hazard Ratio:3.52,95%Confidence interval:1.61-7.70,p=0.002);Meanwhile,patients in the third cate gory had highest risk of all-cause mortality(CONUT≥5 v.s.CONUT=0-1 Hazard Ratio:2.61,95%Confidence interval:1.19-5.74,p=0.017)in multivariate Cox regre ssion analysis.Kaplan-Meier curves indicated that patients with high CONUT sc ores had higher rates of death(Pairwise log-rank CONUT≥5 v.s.CONUT=0-1 P<0.001,CONUT≥5 v.s.2-4 p<0.001,respectively).Area under time-dependentreceiv er operating characteristic(ROC)curve(AUC)for the long-term mortality was 0.83(95%Confidence interval:0.72-0.93)at 6 months,0.83(95%Confidence interval:0.72-0.93)at 12 months,and the optimum cutoff was 5 scores both.Conclusion Malnutrition is universal in patients with STEMI complicated by C HF patients.Objective nutritional indice such as CONUT score is independently associated with long-term mortality among theses special patients.