Association of Prognostic Nutritional Index with Post-Discharge Bleeding After Percutaneous Coronary Intervention in ACS Patients on DAPT

Nasima Mohamed Elkenany,1 Zia Ul Sabah,2 Nadia Ahmed Agiba,1 Hanaa Kamel Elmahdy,1 Eman Aziz Yousef Elsherbiny,1 Salwa Rashad Aly Said,1 Eman Mostafa Nassef,1 Ahmed Mohamed Ewis Alhawy,3 Marwan Sayed Mohamed Ahmed,3 Ashraf Mohammed Said Elsharkawy,3 Amr Mahmoud Mohamed Hussein,3 Abeer Ahmed Elmalah1 1Faculty of Medicine (for Girls), Al Azhar University, Cairo, Egypt; 2Department of Medicine, College of Medicine, King Khalid University; Prince Faisal Bin Khalid Cardiac Centre, Abha, Aseer, Saudi Arabia; 3Faculty of Medicine (for Boys), Al Azhar University, Cairo, EgyptCorrespondence: Zia Ul Sabah, Department of Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia, Tel +966536130888, Email [email protected]: Malnutrition increases bleeding risk by reducing thrombogenicity, impairing platelet aggregation, prolonging bleeding time, and promoting systemic inflammation, which affects vascular permeability and angiogenesis. The Prognostic Nutritional Index (PNI), calculated from serum albumin and lymphocyte count, reflects both nutritional and inflammatory status. This study aimed to assess PNI’s association with bleeding risk in acute coronary syndrome (ACS) patients on dual antiplatelet therapy (DAPT).Patients and Methods: This prospective, single-center observational cohort study enrolled 1843 patients presenting with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI). ROC analysis determined 42.7 as the optimal PNI cut-off value for risk stratification. Participants were stratified into distinct groups based on Prognostic Nutritional Index (PNI) cut-off values, a composite marker derived from serum albumin levels and peripheral lymphocyte counts, reflecting both nutritional and inflammatory status. Patients were prospectively followed for 12 months post-discharge to assess the occurrence of actionable bleeding events, with the aim of evaluating the association between PNI and post-PCI bleeding risk.Results: The study cohort had a mean age of 66.4, with 65.16% male. After PCI, 98.04% were on DAPT. Patients were divided into Group I (PNI ≥ 42.7, n = 1290) and Group II (PNI < 42.7, n = 553). During follow-up, 5.58% of patients experienced actionable bleeding, with 3.5% in Group I and 10.3% in Group II (p < 0.0001). Multivariable Cox regression analysis revealed that PNI < 42.7 was a significant independent predictor of bleeding (HR: 1.7; 95% CI: 1.1– 2.5; p < 0.003).Conclusion: Baseline PNI is an independent predictor of post-discharge bleeding in ACS patients on DAPT after PCI, suggesting it could be a valuable tool for risk stratification of bleeding in these patients. Keywords: prognostic nutritional index, acute coronary syndrome, dual antiplatelet therapy