Malnutrition and Clopidogrel Non-Use Worsen Prognosis of Critical Limb Ischemia Patients After Revascularization

Abstract

Background: Critical limb ischemia (CLI) patients have high risk for major adverse cerebrovascular and cardiovascular events. This study investigated the risk factors of cerebrovascular or cardiovascular death in CLI patients with concomitant coronary artery disease (CAD). Methods and Results: The association between baseline characteristics and cerebrovascular or cardiovascular death ≤2 years after revascularization for CLI was investigated in 137 CLI patients who previously underwent successful revascularization for CAD before treatment for CLI. Twenty-three patients (17%) died. Geriatric nutritional risk index (GNRI) in the deceased group (DG) was significantly lower than in the surviving group (SG). On Cox proportional hazard multivariate analysis, hemodialysis (HD) and malnutrition (defined as GNRI <92) were significantly associated with cerebrovascular or cardiovascular death. Also, on Kaplan-Meier analysis, survival rate was significantly lower in CLI patients with either malnutrition or HD compared with patients without either malnutrition or HD, respectively. Furthermore, clopidogrel was less used in the DG than in the SG. The use of clopidogrel was associated with cerebrovascular or cardiovascular death. Especially, non-use of clopidogrel in the malnutrition group further increased the correlation with cerebrovascular or cardiovascular death. Conclusions: Malnutrition is a crucial risk factor for cerebrovascular and cardiovascular death in CLI patients with CAD. Nutritional status intervention and use of clopidogrel may be an important strategy for CLI.

Current Understanding of the Role of Frailty in Cardiovascular Disease

“…Malnutrition, as defined by a GNRI <92, was significantly associated with cerebrovascular or cardiovascular death. 64 In another clinical study, investigating 104 patients with either PAH or chronic thromboembolic PH, the incidence of PH rehospitalization was higher in the low GNRI group (<92) than that in the high GNRI group (≥92). The cumulative event-free rate was significantly lower in the low GNRI group.…”

“…63 Recently, we reported that malnutrition, assessed using GNRI, affected the prognosis of patients with either PAD/CLI or PAH. 64,65 We investigated 137 CLI patients who had previously undergone successful revascularization for CAD. Twentythree (17%) patients died, and the GNRI level among the deceased group was significantly lower than that among the surviving group.…”

Predictive Value of Geriatric Nutritional Risk Index in Patients With Lower Extremity Peripheral Artery Disease: A Meta-Analysis

“…However, the value of the GNRI score by continuous analysis in predicting amputation was not statistically significant. Moreover, malnutrition defined by the GNRI <92 was significantly associated with cerebrovascular or cardiovascular mortality in CLTI patients after revascularization ( 24 ). These findings suggest that nutritional status determined by the GNRI may provide some important prognostic information in patients with lower extremity PAD.…”

Malnutrition is one of new risk factors in patients with hypertension: the message form Fukushima Cohort Study

“…Nutritional status has been found to affect the outcome of various diseases [2][3][4]. Especially, malnutrition is an important factor in frailty and sarcopenia, which have become major clinical problems in recent years, and has been reported to be associated with poor prognosis for patients with chronic diseases such as heart and renal failure [5,6].…”