Sudo Mitsumasa, Arai Riku, Kojima Keisuke, Tachibana Eizo, Atsumi Wataru, Matsumoto Michiaki, Matsumoto Naoya, Nomoto Kazumiki, Kogo Takaaki, Arima Ken, Arai Masaru, Koyama Yutaka, Oiwa Koji, Haruta Hironori, Okumura Yasuo
Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
Department of Cardiology, Kawaguchi Municipal Medical Center, Kawaguchi, Japan.
Int J Cardiol Heart Vasc. 2025 Mar 11;57:101645. doi: 10.1016/j.ijcha.2025.101645. eCollection 2025 Apr.
The association between hepatorenal function, assessed by the Model for End-stage Liver Disease eXcluding International normalized ratio (MELD-XI) score, and clinical prognosis remains unclear in patients undergoing percutaneous coronary intervention (PCI). The aim of this study was to evaluate the clinical implications of the MELD-XI score.
Consecutive patients who underwent PCI from June 2020 to September 2022 in the SAKURA PCI2 Antithrombotic registry, a multi-center observational prospective cohort study, were reviewed. Patients with missing data for calculating the MELD-XI score were excluded. Study participating patients were stratified into two groups based on the MELD-XI score: high (>10) and low (≤10). The primary outcome was defined as two-year all-cause mortality. The secondary outcome was defined as major bleeding in accordance with the Bleeding Academic Research Consortium 3 or 5.
Among 1064 patients, 265 (24.9 %) were stratified into a high MELD-XI score. Patients with a high MELD-XI had higher two-year all-cause mortality than those with a low MELD-XI score (19.6 % vs. 4.7 %, log-rank p < 0.01). This association was supported in the multivariable analysis (adjusted HR 3.26, 95 %CI 1.84-5.75, p < 0.01) and further supported by spline curve analysis. A high MELD-XI score was also associated with an increased risk of major bleeding (adjusted HR 2.94, 95 %Ci 1.55-5.56, p < 0.01).
A high MELD-XI score was associated with an increased risk of all-cause mortality and major bleeding within two years. Therefore, the MELD-XI score could provide valuable additional information for risk stratification in patients undergoing PCI.
在接受经皮冠状动脉介入治疗（PCI）的患者中，通过终末期肝病模型排除国际标准化比值（MELD-XI）评分评估的肝肾功 能与临床预后之间的关联仍不明确。本研究的目的是评估MELD-XI评分的临床意义。
回顾了在多中心观察性前瞻性队列研究SAKURA PCI2抗栓注册研究中，2020年6月至2022年9月期间接受PCI的连续患者。排除计算MELD-XI评分时数据缺失的患者。根据MELD-XI评分将参与研究的患者分为两组：高（>10）和低（≤10）。主要结局定义为两年全因死亡率。次要结局定义为符合出血学术研究联盟3或5标准的大出血。
在1064例患者中，265例（24.9%）被分层为高MELD-XI评分。高MELD-XI评分患者的两年全因死亡率高于低MELD-XI评分患者（19.6%对4.7%，对数秩p<0.01）。多变量分析支持这种关联（调整后HR 3.26，95%CI 1.84-5.75，p<0.01），样条曲线分析进一步支持。高MELD-XI评分也与大出血风险增加相关（调整后HR 2.94，95%CI 1.55-5.56，p<0.01）。得出结论：高MELD-XI评分与两年内全因死亡率和大出血风险增加相关。因此，MELD-XI评分可为接受PCI的患者进行风险分层提供有价值的额外信息。
