Unmasking Risk Behind the Obesity-Paradox Signal: Prognostic Value of CONUT Score Combined with BMI

Area of Science:

• Cardiology
• Nutritional Science
• Clinical Risk Stratification

Background:

• The "obesity paradox" suggests better outcomes for overweight cardiovascular patients.
• The prognostic impact of poor nutritional status, even in obese individuals, remains unclear.
• Percutaneous coronary intervention (PCI) patients require accurate risk stratification.

Purpose of the Study:

• To evaluate if combining body mass index (BMI) with the Controlling Nutritional Status (CONUT) score refines the interpretation of the obesity paradox in PCI patients.
• To assess the combined prognostic value of BMI and CONUT score on clinical outcomes.

Main Methods:

• Analysis of 631 patients from the SAKURA-PCI2 Registry (2020-2022).
• Patients classified into four groups based on CONUT score (0-1 vs. ≥2) and BMI (<25 kg/m² vs. ≥25 kg/m²).
• Primary endpoint: composite of all-cause death, myocardial infarction, stent thrombosis, heart-failure hospitalization, major bleeding, stroke, and venous thromboembolism over a median follow-up of 2.4 years.

Main Results:

• Malnutrition (CONUT ≥2) was associated with higher risk regardless of BMI.
• Among nutritionally preserved patients (CONUT 0-1), obesity (BMI ≥25) showed a non-significant trend towards fewer events compared to non-obese.
• In multivariable-adjusted models, malnutrition significantly increased risk (HR 2.25 for Group 4, HR 2.18 for Group 3) compared to obese, nutritionally preserved patients (Group 2).

Conclusions:

• The obesity paradox is primarily observed in patients with preserved nutritional status.
• Poor nutritional status, identified by the CONUT score, is a stronger driver of adverse outcomes than obesity in PCI patients.
• Nutritional assessment using the CONUT score may enhance BMI-based risk stratification following PCI.