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Malnutrition-associated high bleeding risk with low thrombogenicity in patients undergoing percutaneous coronary

Nobuhiro Nakanishi1, Koichi Kaikita2, Masanobu Ishii1

  • 1Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.

Nutrition, Metabolism, and Cardiovascular Diseases : NMCD
|February 24, 2022
PubMed

Insights

Malnourished coronary artery disease (CAD) patients with lower geriatric nutritional risk index (GNRI) scores show reduced thrombogenicity, increasing their risk of bleeding events after percutaneous coronary intervention (PCI). This highlights GNRI as a predictor of bleeding risk.

Area of Science:

  • Cardiology
  • Thrombosis Research
  • Geriatric Medicine

Background:

  • Antithrombotic treatments for coronary artery disease (CAD) increase bleeding risk, particularly in malnourished patients.
  • The Total Thrombus-Formation Analysis System (T-TAS) assesses thrombogenicity in CAD.
  • Malnutrition is a significant concern in patients undergoing percutaneous coronary intervention (PCI).

Purpose of the Study:

  • To investigate the relationship between malnutrition, thrombogenicity, and 1-year bleeding events in CAD patients undergoing PCI.
  • To evaluate the utility of the Geriatric Nutritional Risk Index (GNRI) in predicting bleeding risk.
  • To assess the role of T-TAS in evaluating thrombogenicity in relation to nutritional status.

Main Methods:

  • Retrospective analysis of 300 consecutive CAD patients undergoing PCI.
  • Blood samples analyzed using T-TAS to measure thrombus formation.
  • Patients categorized into lower (GNRI ≤98) and higher (GNRI >98) groups.
  • Bleeding events defined by Bleeding Academic Research Consortium (BARC) criteria (types 2, 3, or 5).

Main Results:

  • Lower GNRI group exhibited lower T-TAS levels compared to the higher GNRI group.
  • Kaplan-Meier analysis revealed worse 1-year bleeding event-free survival in the lower GNRI group.
  • A combined model of GNRI and Academic Research Consortium for High Bleeding Risk (ARC-HBR) demonstrated good predictive performance for bleeding events.

Conclusions:

  • A lower GNRI score may indicate reduced thrombogenicity as assessed by T-TAS.
  • GNRI, in conjunction with ARC-HBR positivity, can help determine bleeding risk in CAD patients.
  • Nutritional status is a critical factor influencing thrombogenicity and bleeding risk post-PCI.
Abstract

Keywords:
ARC-HBRBleedingGNRIPCIT-TAS

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