# Clinical implications of the MELD-XI score in patients undergoing percutaneous coronary intervention: Insights from the SAKURA PCI2 Antithrombotic registry

## TL;DR

The MELD-XI score helps predict major bleeding and mortality in patients undergoing heart procedures, offering useful risk assessment.

## Contribution

The study shows the MELD-XI score is a valuable tool for risk assessment in PCI patients.

## Key findings

- A high MELD-XI score is linked to higher two-year all-cause mortality in PCI patients.
- A high MELD-XI score is associated with increased risk of major bleeding after PCI.
- The MELD-XI score's predictive power for bleeding is comparable to other risk scores.

## Abstract

•The MELD-XI score was related to major bleeding and mortality in PCI patients.•The c-statistics of the MELD-XI score for bleeding was comparable to other risks.•The MELD-XI can provide valuable information for risk assessment before the PCI.

The MELD-XI score was related to major bleeding and mortality in PCI patients.

The c-statistics of the MELD-XI score for bleeding was comparable to other risks.

The MELD-XI can provide valuable information for risk assessment before the PCI.

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.