mpact of Nutritional Status and Cardiopulmonary Exercise Testing-Based Exercise Education on Long-Term Outcomes in Acute Coronary Syndrome　- Insights From the Mie ACS Registry.

Abstracts No Comments

Murakami H; Department of Cardiology and Nephrology, Mie University Graduate School of Medicine Mie Japan.
Fujimoto N; Moriwaki K; Ito H; Takasaki A; .Watanabe K; Kambara A; Kumagai N; Omura T; DKurita T;Momosaki R; Dohi K

Circulation reports [Circ Rep] 2024 Nov 09; Vol. 6 (12), pp. 583-591.
Date of Electronic Publication: 2024 Nov 09 (Print Publication: 2024).

Background: Exercise training based on cardiopulmonary exercise testing (CPET) improves outcomes in patients with acute coronary syndrome (ACS), while nutritional status is also crucial. This study evaluated CPET implementation and the impacts of clinical parameters, including CPET and nutritional status, on 2-year outcomes in ACS patients.
Methods and Results: Data from 2,621 ACS patients enrolled in the Mie ACS registry were analyzed. Of these, 938 were hospitalized in CPET-equipped facilities, while 1,683 were not. Nutritional status was assessed using controlling nutritional status (CONUT) score. Cox regression analysis evaluated the associations between nutritional status, CPET-based exercise education, and 2-year prognosis. Among the 938 patients in CPET facilities, 359 underwent CPET and received exercise education. During the 2-year follow up, 60 all-cause deaths occurred. Univariate Cox regression revealed that CPET implementation was associated with lower all-cause mortality. Other predictors included hemoglobin levels, age, hospitalization length, Killip class ≥2, mechanical support, and malnutrition. In multivariate Cox regression, CPET implementation remained an independent predictor of mortality (hazard ratio 0.47; P=0.04). However, when nutritional status was included, moderate to severe malnutrition emerged as an independent predictor of all-cause mortality (hazard ratio 2.47; P=0.02), diminishing the significance of CPET (P=0.058).
Conclusions: Moderate to severe malnutrition is a powerful independent prognostic factor for mortality in the Mie ACS registry. CPET implementation may enhance survival in ACS patients.
Competing Interests: The authors have no relationships to disclose that are relevant to the contents of this manuscript. K.D. received lecture fees from Otsuka Pharmaceutical Co., Ltd, Daiichi Sankyo Company Limited, Nippon Boehringer Ingelheim Co., Ltd, Novartis Japan, and Takeda Pharmaceutical Company Limited. K.D. received departmental research grant support from Daiichi Sankyo Company Limited, Shionogi Co., Ltd, Takeda Pharmaceutical Company Limited, Abbott Japan LLC, Otsuka Pharmaceutical Co., Ltd, Novartis Japan, Kowa Company, Ltd, Dainippon Sumitomo Pharma Co., Ltd, and Ono Pharmaceutical Co., Ltd. The other authors have no financial conflicts of interest to disclose.