Prognostic value of albumin–bilirubin score for major adverse cardiovascular events after percutaneous coronary intervention: A retrospective cohort study using the MIMIC-IV database

Percutaneous coronary intervention (PCI) is a standard treatment for coronary artery disease, yet early mortality remains a major concern. The albumin-bilirubin (ALBI) score, a simple indicator of hepatic function, has shown prognostic value in several clinical settings, but its predictive role in PCI patients has not been clarified. We performed a retrospective cohort study using the MIMIC-IV database. A total of 18,508 adult intensive care unit (ICU) patients who underwent PCI were included. ALBI scores were calculated and patients stratified into standard grades. The primary outcomes were ICU mortality and 28-day all-cause mortality after discharge. Multivariable Cox proportional hazards models were applied to assess the association between ALBI and outcomes, adjusting for demographic, clinical, and laboratory covariates. Restricted cubic splines explored potential nonlinear associations, and Kaplan-Meier analyses compared survival across ALBI strata. We initially screened 18,508 ICU admissions from the MIMIC-IV database. After applying inclusion and exclusion criteria, 17,184 patients were eligible for analysis, of whom 1602 underwent PCI. The overall ICU mortality was 7.8%, and 28-day postdischarge mortality was 9.6%. Patients in the highest ALBI grade had markedly worse outcomes, with a 28-day mortality of 18.4% compared with 6.2% in the lowest grade (log-rank P <.001). In fully adjusted Cox models, each 1-unit increase in ALBI was associated with a 32% higher risk of death (HR 1.32, 95% CI 1.18-1.47, P <.001). Restricted cubic spline analysis demonstrated a nonlinear relationship, with mortality risk rising steeply once ALBI exceeded-1.4. Findings were consistent across sensitivity and subgroup analyses. The ALBI score is an independent predictor of short-term mortality in PCI patients. As a readily available and inexpensive biomarker, ALBI may improve peri-procedural risk stratification and help identify high-risk individuals for targeted management. Prospective studies are warranted to validate these findings and to investigate underlying mechanisms.