Association between Malnutrition and Coronary Plaque Characteristics in Patients with Acute Coronary Syndrome: An Optical Coherence Tomography Study

Background: Malnutrition has a negative impact on patients with arteriosclerotic cardiovascular disease (ASCVD); however, only a few studies have confirmed the effect of malnutrition on atherosclerosis. We aimed to investigate the association between malnutrition and vulnerable plaques via optical coherence tomography (OCT). Methods: Overall, 142 acute coronary syndrome (ACS) patients were included in this study. Malnutrition was assessed using the Controlled Nutritional Status Score (CONUT), and plaque vulnerability was measured using OCT. Finally, patients were divided into four groups according to their CONUT scores and body mass index (BMI) $\geq$ 25.0 or not, to further compare the effects of both factors on plaque characteristics in patients. Results: OCT results showed that there were significant differences in plaque rupture, thin cap fibroatheroma (TCFA), minimal fiber cap thickness (FCT), thrombus, and macrophage infiltration between different nutritional states [Absent (0–1) vs Mild (2–4) vs Moderate (5–8), plaque rupture: 34.8% vs 52.5% vs 66.7%, p = 0.038; TCFA: 10.1% vs 24.6% vs 33.3%, p = 0.039; minimal FCT: 125.0 vs 110.4 vs 96.9, p = 0.022; thrombus: 50.7% vs 70.5% vs 83.3%, p = 0.019]. Multivariate logistic regression showed that malnutrition was a significant predictor of plaque vulnerability. Plaque rupture: CONUT score (odds ratio [OR]: 1.448, 95% confidence interval [CI]: 1.136–1.845, p = 0.003), Mild (OR: 1.981, 95% CI: 0.932–4.210, p = 0.075), and Moderate (OR: 4.375, 95% CI: 1.048–18.255, p = 0.043); TCFA: CONUT score (OR: 1.334, 95% CI: 1.029–1.730, p = 0.030), Mild (OR: 3.518, 95% CI: 1.251–9.897, p = 0.017), and Moderate (OR: 4.863, 95% CI: 1.019–23.208, p = 0.047); and macrophage: CONUT score (OR: 1.343, 95% CI: 1.060–1.700, p = 0.015), Mild (OR: 3.016, 95% CI: 1.305–6.974, p = 0.010), and Moderate (OR: 4.637, 95% CI: 1.159–18.552, p = 0.030). Combined CONUT score and BMI showed an independent association with macrophages in the malnourished and overweight group (OR: 4.010, 95% CI: 1.188–13.537, p = 0.025). Conclusions: Malnutrition is a predictor of vulnerable plaques and is associated with inflammatory progression.