Background: We investigated the prognostic value of nutritional indices in patients with atrial fibrillation (AF) undergoing percutaneous left atrial appendage occlusion (LAAO). Methods: This two-center retrospective study enrolled 151 patients (median age 75, IQR: 69–80) undergoing LAAO. The Controlling Nutritional Status (CONUT) score, Geriatric Nutritional Risk Index (GNRI), and Prognostic Nutritional Index (PNI) were calculated preoperatively. Endpoints included all-cause mortality (primary), postoperative bleeding, and stroke. Associations with mortality were analyzed using multivariable Cox regression models. Results: Over a median follow-up of 8 months (IQR: 5–13), 28 patients (18.5%) died. In multivariable analyses (adjusted for age, sex, diabetes, and chronic kidney disease), each 1-point increase in the CONUT score was associated with a higher risk of all-cause mortality (HR 1.196, 95% CI 1.029–1.390; p = 0.020), whereas higher GNRI values were associated with a lower mortality risk (HR 0.956, 95% CI 0.915–0.998; p = 0.042). In contrast, PNI was not associated with mortality (p = 0.993). Nutritional indices did not significantly predict secondary outcomes like bleeding or stroke. Conclusions: These findings suggest that malnutrition is strongly and independently associated with mortality in high-risk AF patients receiving LAAO. The CONUT score demonstrates the most robust association in this population, highlighting the importance of metabolic reserves.

Objective: The SYNTAX score quantifies coronary lesion complexity and guides revascularization in coronary artery disease (CAD). Readily available biomarkers that reflect lesion burden may improve preangiography risk stratification. This study evaluated whether calculated serum osmolality is associated with lesion complexity in stable CAD. Methods: Adults undergoing elective coronary angiography between January and December 2023 were retrospectively analyzed. Serum osmolality was calculated as 2×[Na ⁺ ]+[BUN/2.8]+[Glucose/18]. Patients were classified as having a low (≤22) or moderate-high (>22) SYNTAX score. Variables identified by least absolute shrinkage and selection operator (LASSO) regression were tested in multivariable logistic regression. Results: A total of 281 patients were included; 195 (69.4%) had a low SYNTAX score, and 86 (30.6%) had a moderate-high SYNTAX score. Median osmolality was significantly higher in the moderate-high group than in the low-score group (293.2 vs. 288.1mOsm/kg; p<0.001). In multivariable analysis, serum osmolality was the strongest independent predictor of a high SYNTAX score (OR, 1.123; 95% CI, 1.070–1.184; p<0.001), along with age, chronic obstructive pulmonary disease, and lipid parameters. Receiver operating characteristic analysis revealed an area under the curve of 0.75 (95% CI, 0.69–0.81). Conclusion: Calculated serum osmolality, a simple and universally available parameter, is independently associated with angiographic lesion complexity in stable CAD and may contribute to preangiography risk stratification and revascularization planning.