Key result
Admission MELD-XI score ≥9.76 linked to ~413% higher 28-day mortality in STEMI.
Why the study?
Effective risk stratification is essential for patients with acute STEMI, but the application of the MELD-XI score to STEMI patients in emergency department settings remains underexplored.
Does an elevated MELD-XI score predict 28-day all-cause mortality in adult patients presenting to the emergency department with STEMI?
Cohort (n=237)
No
Does an elevated MELD-XI score predict 28-day all-cause mortality in adult patients presenting to the emergency department with STEMI?
Answers are grounded in this paper and cite their sources.
The MELD-XI score is a valuable prognostic tool that enhances conventional risk stratification by independently predicting 28-day mortality in STEMI patients presenting to the emergency department.
Aim: Effective risk stratification is essential for patients with acute ST-elevation myocardial infarction (STEMI) to enable timely and appropriate interventions. Liver dysfunction has emerged as a significant predictor of poor cardiovascular outcomes. The Model for End-stage Liver Disease (MELD)-XI score, initially designed to assess liver disease severity, has demonstrated prognostic value in cardiovascular contexts; however, its application to STEMI patients in emergency department (ED) settings remains underexplored. Material and Methods: This retrospective study was conducted at Mugla Training and Research Hospital from July 2019 to January 2021. It included adult STEMI patients diagnosed per the European Society of Cardiology criteria. The primary outcome was 28-day allcause mortality. Statistical analyses included univariate and Cox regression for mortality predictors and Receiver Operating Characteristic and Kaplan-Meier analyses to assess the MELD-XI score's predictive accuracy. Results: Among 237 patients, 8.4% (n=20) died within 28 days. Non-survivors had significantly higher MELD-XI scores (10.72 vs. 9.44, p<0.001) and lower left ventricular ejection fractions (LVEF) (35% vs. 50%, p<0.001). A MELD-XI score threshold of 9.76 predicted mortality with 80% sensitivity and 70.5% specificity (AUC=0.813) and was negatively correlated with LVEF (r=-0.223, p<0.001). Kaplan-Meier analysis showed that patients with MELD-XI scores above 9.76 had significantly higher 28-day mortality (Log-rank test = 5.43, p<0.001). Independent predictors of mortality included MELD-XI score ≥9.76, age, cardiac arrest on admission, glucose, and hemoglobin levels. Conclusion: The MELD-XI score is a valuable prognostic tool for assessing 28-day mortality risk in STEMI patients in EDs. By incorporating liver and renal function indicators, the MELD-XI score enhances conventional risk stratification and facilitates more targeted clinical interventions.
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Ertuğrul et al. (2025) conducted a cohort in ST-Segment Elevation Myocardial Infarction (STEMI) (n=237). MELD-XI score ≥9.76 vs. MELD-XI score <9.76 was evaluated on 28-day all-cause mortality (OR 5.132, 95% CI 1.548-17.020, p=0.007). A MELD-XI score ≥9.76 upon emergency department admission independently predicted 28-day all-cause mortality in patients with STEMI (OR 5.132).
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