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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Prognostic Value of Total Bilirubin in Patients With ST-Segment Elevation Acute Myocardial Infarction Undergoing
Xiaoxiao Zhao1, Ying Wang1, Chen Liu1
1Department of Cardiology, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Fuwai Hospital, Beijing, China.
Insights
Higher total bilirubin (TBil) levels in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI) are linked to better long-term outcomes. A novel TBil-based score aids in predicting major adverse cardiovascular events (MACE).
Area of Science:
- Cardiology
- Biochemistry
- Clinical Risk Prediction
Background:
- Bilirubin, a heme catabolism product, possesses antioxidant and anti-inflammatory properties.
- Previous studies show an inverse association between bilirubin and stable coronary artery disease.
- The prognostic value of bilirubin in ST-segment elevation myocardial infarction (STEMI) patients post-primary percutaneous coronary intervention (PPCI) was previously unknown.
Purpose of the Study:
- To investigate the relationship between total bilirubin (TBil) levels and long-term outcomes in STEMI patients undergoing PPCI.
- To develop a predictive score model incorporating TBil for major adverse cardiovascular events (MACE).
- To stratify patient risk for tailored levels of care.
Main Methods:
- Analysis of 4,151 STEMI patients who underwent PPCI, with 3,708 cases included.
- Measurement of total bilirubin (TBil) levels upon admission.
- Development of a prediction score model using TBil, age, hypertension history, and eight other variables.
Main Results:
- Patients with higher TBil levels (≥22 μmmol/L) exhibited significantly lower MACE rates compared to those with lower levels (<22 μmmol/L) (3.5% vs. 11.0%, p=0.001).
- Multivariate analysis confirmed TBil levels as a significant predictor of MACE (HR, 0.279; 95% CI, 0.088-0.877; p=0.029).
- The developed TBil score effectively stratified patients into low-, medium-, and high-risk categories for MACE, all-cause death, cardiac death, recurrent MI, and ischemic stroke, outperforming the GRACE score (AUC=0.768).
Conclusions:
- A novel prediction score model incorporating total bilirubin shows promise for clinical application.
- This TBil-based score can effectively support risk stratification in STEMI patients undergoing PPCI.
- The model aids in guiding clinical practice and patient management according to established guidelines.
Abstract:
Background: Bilirubin, a natural product of heme catabolism, has antioxidant and anti-inflammatory activities and is inversely associated with stable coronary artery disease. However, the relationship between the bilirubin levels and long-term outcomes in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PPCI) remains unknown. This study aimed to establish a score model based on bilirubin for predicting major adverse cardiovascular events (MACEs) and stratify patients to the level of care. Methods and Results: Data of 4,151 consecutive patients with STEMI who underwent PPCI were evaluated, and 3,708 cases were analyzed. The total bilirubin (TBil) levels were measured during admission, and the study population was divided into two groups. The high TBil group (n = 143) comprised patients who had a TBil level of ≥22 μmmol/L, and the low TBil group (n = 3,565) comprised patients who had a TBil level of <22 μmmol/L. The median follow-up period was 754 days (2.066 years). The MACE was significantly lower in the high TBil group than in the low TBil group (3.5% vs. 11.0%, p = 0.001). In the multivariate Cox regression analysis, a significant association was noted between the TBil levels and adjusted risk of MACE (hazard ratio, 0.279; 95% confidence interval, 0.088-0.877; p = 0.029). A prediction score model composed of TBil, age, hypertension history, and other eight variables was developed, with scores ranging from 0 to 500. The scores categorized patients into low-, medium-, and high-risk categories. The cumulative survival rate was significantly higher in the low-risk group than in the medium- and high-risk groups for MACE, all-cause death, cardiac death, recurrent myocardial infarction, and ischemic stroke (p < 0.001, p < 0.001, p < 0.001, p = 0.030, and p = 0.001, respectively). The area under the curve of the TBil score was 0.768; this was significantly greater in the pairwise comparison with the Global Registry of Acute Coronary Events score (p = 0.0012). Conclusion: The new prediction score model based on TBil could be used in clinical practice to support risk stratification as recommended in the clinical guidelines.
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