Department of Coronary Heart Disease, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Langshan Road 12, Shenzhen, 518000, China.
Department of Coronary Heart Disease, Peking University Shenzhen Hospital, 1120 Lianhua St, Futian District, Shenzhen, 518000, China.
BMC Cardiovasc Disord. 2021 Jan 28;21(1):53. doi: 10.1186/s12872-021-01862-5.
The model for end-stage liver disease excluding international normalized ratio (MELD-XI) is a simple score for risk assessment. However, the prognostic role of MELD-XI and its additional value to current risk assessment in elderly patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) is uncertain.
In all, 1029 elderly patients with STEMI undergoing PCI were consecutively included and classified into three groups according to the TIMI risk score: low-risk (≤ 3, n = 251); moderate-risk (4-6, n = 509); and high-risk (≥ 7, n = 269) groups. Multivariate analysis was performed to identify risk factors for adverse events.
The overall in-hospital mortality was 5.3% and was significantly higher in the high-risk group (1.2% vs. 3.3% vs. 13.0%, p < 0.001). The optimal cut-off of the TIMI risk score and MELD-XI for in-hospital death was 7 and 13, respectively. MELD-XI was associated with in-hospital (adjusted odds ratio = 1.09, 95% CI = 1.04-1.14, p = 0.001) and one-year (adjusted hazard ratio = 1.05, 95% CI = 1.01-1.08, p = 0.005) mortality independently of the TIMI risk score. Combining TIMI risk score and MELD-XI exhibited better predictive power for in-hospital death than TIMI risk score (area under the curve [AUC] = 0.810 vs. 0.753, p = 0.008) or MELD-XI alone (AUC = 0.810 vs. 0.750, p = 0.018). Patients with TIMI risk score ≥ 7 and MELD-XI ≥ 13 had the worst prognosis.
MELD-XI could be considered as a risk-stratified tool for elderly patients with STEMI undergoing PCI. It had an additive prognostic value to TIMI risk score.
模型用于终末期肝病排除国际标准化比值（MELD-XI）是一种简单的风险评估评分。然而，MELD-XI 的预后作用及其在接受经皮冠状动脉介入治疗（PCI）的老年 ST 段抬高型心肌梗死（STEMI）患者中的附加价值尚不确定。
共连续纳入 1029 例接受 PCI 的老年 STEMI 患者，并根据 TIMI 风险评分将其分为三组：低危组（≤3，n=251）；中危组（4-6，n=509）；高危组（≥7，n=269）。采用多变量分析确定不良事件的危险因素。
住院总死亡率为 5.3%，高危组明显较高（1.2%比 3.3%比 13.0%，p<0.001）。TIMI 风险评分和 MELD-XI 预测住院死亡的最佳截断值分别为 7 和 13。MELD-XI 与住院期间（校正优势比=1.09，95%可信区间=1.04-1.14，p=0.001）和一年（校正危险比=1.05，95%可信区间=1.01-1.08，p=0.005）死亡率独立相关，而与 TIMI 风险评分无关。TIMI 风险评分和 MELD-XI 联合应用较 TIMI 风险评分（曲线下面积[AUC]=0.810 比 0.753，p=0.008）或 MELD-XI 单独应用（AUC=0.810 比 0.750，p=0.018）具有更好的预测住院死亡的能力。TIMI 风险评分≥7 且 MELD-XI≥13 的患者预后最差。
MELD-XI 可作为接受 PCI 的老年 STEMI 患者的风险分层工具。它对 TIMI 风险评分具有附加的预后价值。
