Department of Cardiology, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People's Republic of China.
Fujian Institute of Coronary Artery Disease, Fuzhou, 350001, Fujian, People's Republic of China.
BMC Cardiovasc Disord. 2022 Mar 18;22(1):113. doi: 10.1186/s12872-022-02556-2.
No-reflow phenomenon (NRP) is one of the complications that mostly occur during percutaneous coronary intervention (PCI). In this study, we comprehensively examined the relationship between the model for end-stage liver disease-XI (MELD-XI) score and NRP. Moreover, we discussed whether the MELD-XI score could be considered as an accurate risk assessment score of patients with ST-segment elevation myocardial infarction (STEMI) who are candidates for PCI.
This retrospective study involved 693 patients with acute STEMI and who underwent an emergency PCI. They were divided into a normal reflow group or a no-reflow group on the basis of the flow rate of post-interventional thrombolysis in myocardial infarction. Univariate, multivariate logistic regression, and Cox regression analyses were performed to identify the independent predictors of NRP in both groups. Receiver operator characteristic (ROC) curves and Kaplan-Meier curves were plotted to estimate the predictive values of the MELD-XI score.
MELD-XI score was found to be an independent indicator of NRP (odds ratio: 1.247, 95% CI: 1.144-1.360, P < 0.001). Multivariate Cox regression analysis also revealed that the MELD-XI score is an independent prognostic factor for 30-day all-cause mortality (hazard ratio: 1.155, 95% CI: 1.077-1.239, P < 0.001). Moreover, according to the ROC curves, the cutoff value of the MELD-XI score to predict NRP was 9.47 (area under ROC curve: 0.739, P < 0.001). The Kaplan-Meier curves for 30-day all-cause mortality revealed lower survival rate in the group with a MELD-XI score of > 9.78 (P < 0.001).
The MELD-XI score can be used to predict NRP and the 30-day prognosis in patients with STEMI who are candidates for primary PCI. It could be adopted as an inexpensive and a readily available tool for risk stratification.
无复流现象（NRP）是经皮冠状动脉介入治疗（PCI）过程中最常发生的并发症之一。本研究全面探讨了终末期肝病模型-XI（MELD-XI）评分与 NRP 之间的关系。此外，我们还讨论了 MELD-XI 评分是否可作为适合行直接经皮冠状动脉介入治疗（PCI）的 ST 段抬高型心肌梗死（STEMI）患者的准确风险评估评分。
本回顾性研究纳入 693 例急性 STEMI 患者，所有患者均接受紧急 PCI。根据介入后心肌梗死溶栓治疗的血流速度，将患者分为正常再灌注组或无复流组。采用单因素、多因素 logistic 回归和 Cox 回归分析确定两组患者 NRP 的独立预测因素。绘制受试者工作特征（ROC）曲线和 Kaplan-Meier 曲线以评估 MELD-XI 评分的预测价值。
MELD-XI 评分是 NRP 的独立预测指标（比值比：1.247，95%置信区间：1.144-1.360，P<0.001）。多因素 Cox 回归分析还表明，MELD-XI 评分是 30 天全因死亡率的独立预后因素（风险比：1.155，95%置信区间：1.077-1.239，P<0.001）。此外，根据 ROC 曲线，MELD-XI 评分预测 NRP 的截断值为 9.47（ROC 曲线下面积：0.739，P<0.001）。30 天全因死亡率的 Kaplan-Meier 曲线显示，MELD-XI 评分>9.78 组的生存率较低（P<0.001）。
MELD-XI 评分可用于预测 STEMI 患者行直接 PCI 治疗后 NRP 及 30 天预后，可作为一种经济、易得的风险分层工具。
