Increased serum bilirubin level is related to good collateral development in patients with chronic total coronary occlusion

Predictive value of bilirubin and serum γ-glutamyltranspeptidase levels in type-2 diabetes mellitus patients with acute coronary syndrome

BACKGROUND

Cardiovascular disease is a major complication of diabetes mellitus (DM). Type-2 DM (T2DM) is associated with an increased risk of cardiovascular events and mortality, while serum biomarkers may facilitate the prediction of these outcomes. Early differential diagnosis of T2DM complicated with acute coronary syndrome (ACS) plays an important role in controlling disease progression and improving safety.

AIM

To investigate the correlation of serum bilirubin and γ-glutamyltranspeptidase (γ-GGT) with major adverse cardiovascular events (MACEs) in T2DM patients with ACS.

METHODS

The clinical data of inpatients from January 2022 to December 2022 were analyzed retrospectively. According to different conditions, they were divided into the T2DM complicated with ACS group (T2DM + ACS, n = 96), simple T2DM group (T2DM, n = 85), and simple ACS group (ACS, n = 90). The clinical data and laboratory indices were compared among the three groups, and the correlations of serum total bilirubin (TBIL) levels and serum γ-GGT levels with other indices were discussed. T2DM + ACS patients received a 90-day follow-up after discharge and were divided into event (n = 15) and nonevent (n = 81) groups according to the occurrence of MACEs; Univariate and multivariate analyses were further used to screen the independent influencing factors of MACEs in patients.

RESULTS

The T2DM + ACS group showed higher γ-GGT, total cholesterol, low-density lipoprotein cholesterol (LDL-C) and glycosylated hemoglobin (HbA1c) and lower TBIL and high-density lipoprotein cholesterol levels than the T2DM and ACS groups (P < 0.05). Based on univariate analysis, the event and nonevent groups were significantly different in age (t = 3.3612, P = 0.0011), TBIL level (t = 3.0742, P = 0.0028), γ-GGT level (t = 2.6887, P = 0.0085), LDL-C level (t = 2.0816, P = 0.0401), HbA1c level (t = 2.7862, P = 0.0065) and left ventricular ejection fraction (LEVF) levels (t=3.2047, P = 0.0018). Multivariate logistic regression analysis further identified that TBIL level and LEVF level were protective factor for MACEs, and age and γ-GGT level were risk factors (P < 0.05).

CONCLUSION

Serum TBIL levels are decreased and γ-GGT levels are increased in T2DM + ACS patients, and the two indices are significantly negatively correlated. TBIL and γ-GGT are independent influencing factors for MACEs in such patients.

Serum total bilirubin and one-year prognosis of patients with coronary artery disease and psoriasis

To evaluate the potential predictive value of total bilirubin (TBIL) for one-year prognosis in patients with coronary artery disease (CAD) and psoriasis. 278 psoriasis patients who underwent coronary angiography and were diagnosed as CAD were recruited. Baseline TBIL was measured at admission. Patients were divided into three groups according to the third tertiles of TBIL. The coronary angiography showed that lower TBIL was associated with the severity of lesion calcification. After a mean follow-up of 315 days, major adverse cardiac and cerebrovascular events (MACCEs) were reported in 61 patients. Compared with patients with higher TBIL tertiles, the incidence of MACCEs increased significantly in patients with middle and lower TBIL tertiles. The incidence of MACCEs in one-year follow-up was significantly different between higher and lower tertiles. The findings indicate that decreased TBIL is a potential predictor of poor prognosis in patients with psoriasis and CAD.

Traditional Cardiovascular Risk Factors and Coronary Collateral Circulation: A Meta-Analysis

Objective: Patients with well-developed coronary collateral circulation (CC) usually have low mortality, improved cardiac function, and reduced infarct size. Currently, there is conflicting evidence on the association between traditional cardiovascular risk factors (diabetes, hypertension, and smoking habit) and CC.

Design: We performed a meta-analysis of case-control studies to better understand such associations.

Data Sources: We searched the MEDINE, EMBASE, and Science Citation Index databases to identify relevant studies.

Eligibility Criteria for Selecting Studies: Case control studies reporting data on risk factors (smoking habit, hypertension, and diabetes mellites) in comparing cases between poor CC and well-developed CC groups. Well-developed CC was the primary outcome of this meta-analysis

Data Extraction and Synthesis: Relevant data were extracted by two independent investigators. We derived pooled odds ratios (ORs) with random effects models. We performed quality assessments, publication bias, and sensitivity analysis to ensure the reliability of our results.

Results: In total, 18 studies that had 4,746 enrolled patients were analyzed. Our results showed that hypertension and smoking habit did not (OR = 0.94, 95% CI: 0.75–1.17, p = 0.564 and OR = 1.00, 95% CI: 0.84–1.18, p = 0.970, respectively), and diabetes did (OR = 0.50, 95% CI: 0.38–0.67, p = 0.00001) affect the development of CC.

Conclusion: Unlike hypertension and smoking habit, diabetes was associated with poor CC formation.

Trial Registration Number:https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=87821, identifier: CRD42018087821.

Serum Bilirubin Level Predicts Frontal QRS-T Angle Change in Patients with Acute Coronary Syndrome

Introduction: The predictive role of serum bilirubin levels on the alteration of total ischemic burden expressed via frontal QRS-T angle change has never been studied in patients with acute coronary syndrome (ACS). In this study, we aimed to investigate the relationship between serum bilirubin levels and frontal QRS-T angle change after percutaneous coronary intervention (PCI) in ACS patients.

Methods: Frontal QRS-T angle change was accepted as positive or negative according to whether the value of the baseline frontal QRS-T angle minus the post PCI frontal QRS-T angle is positive or negative. A total of 314 consecutive patients with ACS who underwent PCI were divided into two groups based on their negative frontal QRS-T angle change (n = 152 patients) and positive frontal QRS-T angle change (n = 162 patients).

Results: Multivariate logistic regression analysis showed that the C-reactive protein (CRP) to albumin ratio (CAR) (Odds ratio [OR]: 0.519, 95% CI: 0.373–0.724, p <0.001), total bilirubin (OR: 3.687, 95% CI: 1.151–8.095, p = 0.03), and low-density lipoprotein (LDL) (OR: 0.985, 95% CI: 0.970–1.000, p = 0.04) were independent predictors of positive QRS-T angle change. In receiver operating characteristics curve analysis, a cut-off value of 0.59 total bilirubin had a 69% sensitivity and a 65% specificity (area under curve: 0.739, p <0.001) for the prediction of positive QRS-T angle change.

Conclusion: In ACS patients, serum total bilirubin has been found to be a useful decision-making tool to predict positive frontal QRS-T angle change as a sign of reduced total ischemic burden, to assess early invasive strategy independently from other study parameters.

Correlations between the serum bilirubin level and ulcerative colitis: a case-control study

OBJECTIVE

To analyze whether the bilirubin level is a protective factor in ulcerative colitis (UC) and the predictive value of the bilirubin level.

PATIENTS AND METHODS

We compared the bilirubin levels of 100 UC patients and 140 healthy controls as well as those of the subgroups of patients with different UC severities and then analyzed the correlation between the bilirubin level and UC and the correlations among the erythrocyte sedimentation rate (ESR), high sensitivity C-reactive protein (hs-CRP) level, UC severity, and bilirubin level. The predictive value of the bilirubin level for UC was determined by constructing a receiver operating characteristic (ROC) curve.

RESULTS

The mean levels of the total bilirubin (TBIL) and indirect bilirubin (IBIL) in the UC were lower in comparison with the mean TBIL and IBIL levels in the control group, and the TBIL and IBIL levels were significantly higher in the mild activity subgroup than in the moderate and severe activity subgroups (P<0.05). TBIL (P<0.001, 95% confidence interval: 0.794-0.918) and especially IBIL (P<0.001, 95% confidence interval: 0.646-0.809) were independent protective factors for UC. There were also significant differences in the serum ESR and hs-CRP levels between the patients with different UC severities (ESR=χ: 23.975; hs-CRP=χ: 26.626, P<0.001), and there was a positive correlation between these two parameters (ESR=r: 0.472; hs-CRP=r: 0.495, P<0.001). However, the TBIL and IBIL levels were correlated negatively with the ESR (rtotal=-0.429, rindirect=-0.461, P<0.001) and hs-CRP (rtotal=-0.289, rindirect=-0.25, P<0.05) levels. The ROC curve showed that the threshold values of TBIL and IBIL were 8.87 and 6.735 µmol/l, the areas under the maximum ROC curve were 0.664 and 0.716, the sensitivities were 0.450 and 0.61, and the specificities were 0.800 and 0.786, respectively.

CONCLUSION

TBIL and especially IBIL may be independent protective factors for UC because of their antioxidant and anti-inflammatory effects. A low level of IBIL has a moderate predictive value for UC, and an IBIL level less than 6.735 µmol/l can be used as a defining index for predicting UC.

Prognostic Value of Serum Total Bilirubin after Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome

Backgrounds

Previous studies have reported a relationship between serum total bilirubin (STB) and coronary artery disease (CAD). However, the relationship between STB and prognosis of patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) remains inconclusive. The present study aimed to evaluate the relationship between STB level and prognosis of PCI in patients with ACS.

Methods

In total, 2850 ACS patients who underwent PCI at the Affiliated Zhongda Hospital of Southeast University from June 2009 to Jan 2017 were included in the study. Twenty-four-hour STB, 30-day, and 1-year postoperative major adverse cardiovascular events (MACE) were recorded. Subjects were assigned to one of three groups based on STB: Group A (STB ≤ 9.6 μmol/L), Group B (9.7 μmol/L < STB ≤ 15.4 μmol/L), and Group C (STB ≥ 15.5 μmol/L). COX survival analysis was subsequently used to investigate the relationship between the incidence of MACE and STB in the three groups.

Results

A total of 2770 subjects were successfully followed up; within 1 year after PCI, 115 (4.15%) subjects died and 191 (6.90%) subjects experienced MACE. One-year follow-up results showed that the incidence of MACE decreased significantly as STB increased; the risk of Group A was 2.002 times that of Group C (95% CI: 1.342-2.986). Cardiac mortality also decreased with increasing STB; the risk of Group A was 3.403 times that of Group C (95% CI: 1.319-8.785).

Conclusion

Lower mortality and MACE incidence rates were found in patients with higher STB within 1 year. Therefore, STB is highly recommended as an independent long-term prognosis predictor of PCI in patients with ACS.

Glucuronidated bilirubin: Significantly increased in hepatic encephalopathy

Bilirubin is produced by the breakdown of hemoglobin in senescent erythrocytes by macrophages and carried by albumin from blood circulation to the liver for removal in normal physiology. Glucuronic acid modification of bilirubin by UDP-glucuronyltransferase in the liver is the key event for its subsequent elimination from human body. Conditions that accelerate the breakdown of erythrocytes may cause an elevated blood level of unconjugated bilirubin whereas the factors affect the glucuronidated bilirubin formation and subsequent elimination may cause decreased or increased blood level of glucuronidated bilirubin, the water soluble "direct bilirubin" measured by clinical blood test. Studies showed that increased total serum bilirubin has a protective effect on cardiovascular and other related diseases, but it is unknown how direct bilirubin levels were related to different diseases. By taking advantage of the data collected in the clinical laboratory of our hospital, the direct bilirubin data from 192,535 patients with 72 clinically defined diseases were compared to that of healthy controls (10,497). Based on the mean, median, and p values, we found that patients with hepatic encephalopathy had the highest serum direct bilirubin level, which resembled acute hepatic encephalopathy caused by increased serum direct bilirubin level in neonates. In contrast, patients with uremia, nephrotic syndrome, and preeclampsia had significantly lower levels of serum direct bilirubin. Taken together, our data revealed that serum direct bilirubin levels were either increased or decreased in a disease-dependent manner. The possible molecular mechanisms of increased direct bilirubin levels in patients suffering hepatic encephalopathy are discussed.

Alanine Aminotransferase and Total Bilirubin Are Synergistically Associated with Metabolic Syndrome Among Middle-Aged and Elderly Japanese Women

BACKGROUND

Metabolic syndrome (MetS) is associated with an increased risk of major cardiovascular events. Alanine aminotransferase (ALT) at high levels and total bilirubin (T-BiL) at low levels were oxidative potentials, but it was uncertain whether ALT and T-BiL had an additive interaction for the risk of MetS.

METHODS

From a single community, we recruited 864 women (70 ± 8 years) during their annual health examination. We cross-sectionally investigated whether ALT and T-BiL are associated with MetS and its components based on the modified criteria of the National Cholesterol Education Program's Adult Treatment Panel (NCEP-ATP) III report.

RESULTS

Of these subjects, 415 women (48.0%) had MetS. Participants with MetS had a higher ALT and lower T-BiL level than those without MetS. The adjusted-odds ratios (OR) (95% confidence interval [CI]) for MetS across tertiles of ALT and T-BiL were 1.00, 1.19 (0.78-1.81), and 1.86 (1.24-2.80) and 1.00, 0.96 (0.65-1.43), and 0.54 (0.36-0.81), respectively. When ALT and T-BiL were categorized into three binary characteristics by tertiles of ALT and T-BiL, high T-BiL was associated with decreased risk for MetS in a multivariable model (OR: 0.55, 95% CI: 0.37-0.82), especially among those with 1st tertile ALT. Similarly, high ALT was also associated with increased risk for MetS in a multivariate model (OR: 1.81, 95% CI: 1.20-2.71), especially among those with 2nd & 3rd tertiles of T-BiL. In the formal testing of addictive interaction between ALT and T-BiL for MetS, presence of T-BiL <0.72 mg/dL (1st and 2nd tertile) alone was not associated with increased risk of MetS in a multivariate analysis, and presence of ALT ≥16 IU/L (2nd and 3rd tertile) alone was not associated with increased risk of MetS.

CONCLUSIONS

These results suggested that higher ALT and lower T-BiL levels were synergistically associated with MetS, independent of other confounding factors among Japanese women.

Bilirubin in coronary artery disease: Cytotoxic or protective?

Bilirubin has traditionally been considered a cytotoxic waste product. However, recent studies have shown bilirubin to have anti-oxidant, anti-inflammatory, vasodilatory, anti-apoptotic and anti-proliferative functions. These properties potentially confer bilirubin a new role of protection especially in coronary artery disease (CAD), which is a low grade inflammatory process exacerbated by oxidative stress. In fact, recent literature reports an inverse relationship between serum concentration of bilirubin and the presence of CAD. In this article, we review the current literature exploring the association between levels of bilirubin and risk of CAD. We conclude that current evidence is inconclusive regarding the protective effect of bilirubin on CAD. A causal relationship between low serum bilirubin level and increased risk of CAD is not currently established.

Glucose or Altered Ceramide Biosynthesis Mediate Oxygen Deprivation Sensitivity Through Novel Pathways Revealed by Transcriptome Analysis in Caenorhabditis elegans

Individuals with type 2 diabetes display metabolic abnormalities, such as hyperglycemia, increased free fatty acids, insulin resistance, and altered ceramide levels, that contribute to vascular dysfunctions and compromised oxygen delivery. Caenorhabditis elegans fed a glucose-supplemented diet or with altered ceramide metabolism, due to a hyl-2 mutation, are sensitive to oxygen deprivation (anoxia). Our experiments showed that the combination of these factors further decreased the anoxia survival. RNA-sequencing analysis was performed to assess how a glucose-supplemented diet and/or a hyl-2 mutation altered the transcriptome. Comparison analysis of transcripts associated with anoxia-sensitive animals [hyl-2(tm2031) mutation or a glucose diet] revealed 199 common transcripts encoded by genes with known or predicted functions involving innate immunity, cuticle function (collagens), or xenobiotic and endobiotic phase I and II detoxification system. Use of RNA interference (RNAi) to target gene products of the xenobiotic and endobiotic phase I and II detoxification system (UDP-glycosyltransferase and Cytochrome p450 genes; ugt-15, ugt-18, ugt-19, ugt-41, ugt-63, cyp-13A12, cyp-25A1, and cyp-33C8) increased anoxia survival in wild-type animals fed a standard diet. Anoxia sensitivity of the hyl-2(tm2031) animals was suppressed by RNAi of cyp-25A1 or cyp-33C8 genes. A glucose diet fed to the P0 hermaphrodite decreased the anoxia survival of its F1 embryos; however, the RNAi of ugt-63 and cyp-33C8 suppressed anoxia sensitivity. These studies provide evidence that the detoxification system impacts oxygen deprivation responses and that C. elegans can be used to model the conserved detoxification system.

Looking to the horizon: the role of bilirubin in the development and prevention of age-related chronic diseases

Bilirubin, the principal tetrapyrrole, bile pigment and catabolite of haem, is an emerging biomarker of disease resistance, which may be related to several recently documented biological functions. Initially believed to be toxic in infants, the perception of bilirubin has undergone a transformation: it is now considered to be a molecule that may promote health in adults. Data from the last decade demonstrate that mildly elevated serum bilirubin levels are strongly associated with reduced prevalence of chronic diseases, particularly cardiovascular diseases (CVDs), as well as CVD-related mortality and risk factors. Recent data also link bilirubin to other chronic diseases, including cancer and Type 2 diabetes mellitus, and to all-cause mortality. Therefore, there is evidence to suggest that bilirubin is a biomarker for reduced chronic disease prevalence and a predictor of all-cause mortality, which is of important clinical significance. In the present review, detailed information on the association between bilirubin and all-cause mortality, as well as the pathological conditions of CVD, cancer, diabetes and neurodegenerative diseases, is provided. The mechanistic background concerning how bilirubin and its metabolism may influence disease prevention and its clinical relevance is also discussed. Given that the search for novel biomarkers of these diseases, as well as for novel therapeutic modalities, is a key research objective for the near future, bilirubin represents a promising candidate, meeting the criteria of a biomarker, and should be considered more carefully in clinical practice as a molecule that might provide insights into disease resistance. Clearly, however, greater molecular insight is warranted to support and strengthen the conclusion that bilirubin can prevent disease, with future research directions also proposed.

Circulating bilirubin and defense against kidney disease and cardiovascular mortality: mechanisms contributing to protection in clinical investigations

Unconjugated bilirubin is an endogenous circulating antioxidant, bound to albumin, and therefore is retained in the vascular compartment. Bilirubin has well-documented neurotoxic effects in infants; however, current evidence indicates mildly elevated bilirubin is associated with protection from cardiovascular disease and all-cause mortality in adults. Recent clinical studies show mildly elevated bilirubin is associated with protection from kidney damage and dysfunction, in addition to cardiovascular events and all-cause mortality in patients undergoing hemodialysis. This is the first review to examine the clinical evidence and summarize the potential mechanisms of action that link bilirubin to protection from kidney damage, subsequent kidney failure, and dialysis-related mortality. With this understanding, it is hoped that new therapies will be developed to prevent renal dysfunction and mortality from cardiovascular disease in at-risk individuals.

A novel predictor of infarct-related artery patency before percutaneous intervention and in-hospital outcomes for ST-segment elevation myocardial infarction patients: serum bilirubin level

Introduction

Previous studies have reported a relationship between serum bilirubin levels and coronary artery disease (CAD). However, data are rare up to now regarding the relation of bilirubin levels with infarct-related artery (IRA) patency in the setting of ST-segment elevation myocardial infarction (STEMI). Moreover, previous studies reported that increased bilirubin was related to impaired post-intervention coronary flow. To our knowledge, the association between serum total bilirubin (TB) levels and pre-primary percutaneous coronary intervention (PCI) with patency of IRA flow in STEMI patients has not been investigated.

Aim

To evaluate the association of TB with pre-primary PCI, coronary flow and in-hospital major adverse cardiac events (MACE) in patients with STEMI.

Material and methods

A total of 360 consecutive patients with STEMI (mean age = 61.4 ±13.7 years) admitted within 12 h from the time of symptom onset were enrolled. Patients were divided into 2 groups based on the serum TB levels. We defined normal flow as pre-PCI TIMI 3 flow, while impaired flow was defined as pre-PCI TIMI ≤ 2 flow.

Results

Pre-PCI impaired flow was higher in the TB group than pre-PCI normal flow (p < 0.001). In-hospital mortality and MACE were significantly higher in the high TB group (p = 0.002, p < 0.001 respectively). In the receiver operating characteristic curve analysis, TB > 0.825 mg/dl predicted impaired IRA flow before p-PCI with a sensitivity of 79% and specificity of 71%.

Conclusions

The TB is an inexpensive and readily available marker for STEMI patients undergoing PCI. It can be used for risk stratification in this patient population.

Bilirubin levels and their association with carotid intima media thickness and high-sensitivity C-reactive protein in patients with psoriasis vulgaris

BACKGROUND

Psoriasis vulgaris is associated with an increased risk of atherosclerosis. Carotid intima-media thickness (cIMT) may predict atherosclerosis.

AIMS

We assessed the correlation between bilirubin (a potent endogenous antioxidant) levels and cIMT in patients with psoriasis vulgaris. We also compared the levels of serum total bilirubin (TBil) and its fractions in control subjects and patients with psoriasis.

METHODS

We enrolled 115 participants (60 patients with psoriasis vulgaris and 55 control subjects). The levels of indirect bilirubin were calculated as the difference between TBil and direct bilirubin values. cIMT was measured in both common carotid arteries.

RESULTS

TBil levels were lower in patients with psoriasis than in the control group [median (range) 0.55 (0.30-1.23) vs. 0.59 (0.30-1.44) mg/dL] as were indirect bilirubin [0.43 (0.22-1.00) vs. 0.48 (0.25-1.12) mg/dL] and direct bilirubin [0.10 (0.01-0.23) vs. 0.13 (0.03-0.32) mg/dL]. Only direct bilirubin differed significantly (p=0.0002) but the number of patients with higher values of TBil and indirect bilirubin were significantly greater in the control group (p=0.0019 by the Fisher's test). The patients with psoriasis had a significantly greater cIMT compared with control subjects (0.54±0.08 vs. 0.50±0.07 mm, p=0.005). High-sensitivity C-reactive protein levels were higher in patients with psoriasis compared with controls (2.95±3.50 and 0.99±0.72 mg/L, p<0.001). There was a negative correlation between cIMT and TBil levels (r=-0.383, p<0.01). The results of the correlations were reinforced by multiple regression analysis.

CONCLUSION

To our knowledge, this is the first study to assess the association between TBil and cIMT in patients with psoriasis. Our results support the concept that psoriasis vulgaris is associated with an increased risk of atherosclerosis.

Association of serum total bilirubin levels with diastolic dysfunction in heart failure with preserved ejection fraction

BACKGROUND

Left ventricular diastolic dysfunction is one of the main characteristics of heart failure patients with a preserved left ventricular ejection fraction. As bilirubin is regarded as an important endogenous antioxidant molecule, serum total bilirubin levels were compared between heart failure patients with a preserved left ventricular ejection fraction and normal controls in this study. We recruited 327 heart failure patients with a preserved left ventricular ejection fraction and 200 healthy controls. Patients were divided into 4 subgroups by their comprehensive echocardiographic manifestations, 1-mild, 2-moderate, 3-severe (reversible restrictive), 4-severe (fixed restrictive). Total bilirubin levels were compared using stepwise multiple regressions adjusted for selected factors.

RESULTS

After adjusting for gender, age, smoking, systolic blood pressure, diastolic blood pressure, total cholesterol and triglyceride, serum total bilirubin levels were significantly lower in the heart failure group compared with the control group (P < 0.01). Patients in the subgroup (4-severe) showed significantly (P < 0.05) lower levels of total bilirubin when compared with the subgroup (1-mild).

CONCLUSIONS

TB level was negatively correlated with left ventricular diastolic dysfunction in heart failure patients with a preserved left ventricular ejection fraction, which might provide a new insight into the complicated mechanisms of heart failure with a preserved left ventricular ejection fraction.

Carotid Intima Media Thickness and Its Association With Total Bilirubin Levels in Patients With Coronary Artery Ectasia

Atherosclerosis plays an important role in the etiopathogenesis of coronary artery ectasia (CAE). The relationship between total bilirubin (TBil) and carotid intima media thickness (cIMT) in patients with CAE has not been fully investigated. Hence, we evaluated the relationship between TBil levels and cIMT in 142 consecutive eligible patients with CAE, newly diagnosed coronary artery disease (CAD), and normal coronary arteries. There were no significant differences in TBil ( P = .772) and cIMT ( P = .791) between the CAE and CAD groups. Bilirubin levels were significantly lower in both CAE and CAD groups compared to the controls ( P < .01). The cIMT was significantly higher in both CAE and CAD groups compared to control participants ( P < .01). A negative correlation between cIMT and TBil was found in all the groups ( P < .01, r = .354). We show for the first time that patients with CAE and CAD have lower TBil and greater cIMT compared to controls with normal coronary angiograms.

Prognostic value of total bilirubin in patients with ST-segment elevation acute myocardial infarction undergoing primary coronary intervention

Previous studies have shown that the serum total bilirubin (TB) concentration was inversely related with stable coronary artery disease, diabetes mellitus, hypertension, and metabolic syndromes. The relation between TB levels and in-hospital and long-term outcomes in patients with ST-segment elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (PCI) is not known. Data from 1,624 consecutive patients with STEMI who underwent primary PCI were evaluated. TB was measured after primary PCI, and the study population was divided into tertiles. The high TB group (n = 450) was defined as a value in the upper third tertile (>0.9 mg/dl) and the low TB group (n = 1,174) as any value in the lower 2 tertiles (≤0.9 mg/dl). The in-hospital mortality rate was significantly greater in the high TB group than in the low TB group (4% vs 1.5%, p = 0.003). In the multivariate analyses, a significant association was noted between high TB levels and the adjusted risk of in-hospital cardiovascular mortality (odds ratio 3.24, 95% confidence interval 1.27 to 8.27, p = 0.014). In the receiver operating characteristic curve analysis, TB >0.90 mg/dl was identified as an effective cutpoint in patients with STEMI for in-hospital cardiovascular mortality (area under the curve 0.66, 95% confidence interval 0.55 to 0.76, p = 0.001). The mean follow-up period was 26.2 months. No differences were seen in the long-term mortality rates between the 2 groups. In conclusion, high TB is independently associated with in-hospital adverse outcomes in patients with STEMI who undergo primary PCI. However, no association was found with long-term mortality.