Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 26, 2022; 10(6): 1775-1786
Published online Feb 26, 2022. doi: 10.12998/wjcc.v10.i6.1775
Effects of bilirubin on perioperative myocardial infarction and its long-term prognosis in patients undergoing percutaneous coronary intervention
Ya Li, Duan-Bin Li, Li-Ding Zhao, Qing-Bo Lv, Yao Wang, Ya-Fei Ren, Wen-Bin Zhang
Ya Li, Duan-Bin Li, Li-Ding Zhao, Qing-Bo Lv, Yao Wang, Wen-Bin Zhang, Department of Cardiovascular Diseases, Sir Run Run Shaw Hospital, College of Medicine of Zhejiang University, Hangzhou 310016, Zhejiang Province, China
Ya-Fei Ren, Department of Rehabilitation Medicine, Qilu Institute of Technology, Jinan 250200, Shandong Province, China
Author contributions: Li Y and Li DB reviewed the literature and contributed to manuscript drafting; Lv QB, Wang Y, Zhao LD and Ren YF contributed to data collection, interpretation, and analysis; Zhang WB was responsible for revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Institutional review board statement: The study was reviewed and approved by Sir Run Run Shaw Hospital.
Conflict-of-interest statement: All authors have nothing to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wen-Bin Zhang, MD, Associate Chief Physician, Associate Professor, Department of Cardiovascular Diseases, Sir Run Run Shaw Hospital, College of Medicine of Zhejiang University, No. 3 Qinchundong Road, Hangzhou 310016, Zhejiang Province, China. 3313011@zju.edu.cn
Received: September 8, 2021
Peer-review started: September 8, 2021
First decision: October 27, 2021
Revised: November 14, 2021
Accepted: January 11, 2022
Article in press: January 11, 2022
Published online: February 26, 2022
Processing time: 168 Days and 8.9 Hours
Abstract
BACKGROUND

Although bilirubin is known to be an antioxidant, any relationship with coronary heart disease remains controversial. To the best of our knowledge, no previous study has investigated the association between bilirubin and perioperative myocardial infarction (PMI), including its long-term prognosis.

AIM

To investigate the impact of bilirubin levels on PMI in patients undergoing percutaneous coronary intervention (PCI), and long-term prognosis in post-PMI patients.

METHODS

Between January 2014 and September 2018, 10236 patients undergoing elective PCI were enrolled in the present study. Total bilirubin (TB) and cardiac troponin I (cTnI) levels were measured prior to PCI and cTnI at further time-points, 8, 16 and 24 h after PCI. Participants were stratified by pre-PCI TB levels and divided into three groups: < 10.2; 10.2-14.4 and > 14.4 μmol/L. PMI was defined as producing a post-procedural cTnI level of > 5 × upper limit of normal (ULN) with normal baseline cTnI. Major adverse cardiovascular events (MACEs) included cardiac death, MI, stroke and revascularization during a maximum 5-year follow-up.

RESULTS

PMI was detected in 526 (15.3%), 431 (12.7%) and 424 (12.5%) of patients with pre-PCI TB levels of < 10.2, 10.2-14.4 and > 14.4 μmol/L (P = 0.001), respectively. Multivariate logistical analysis indicated that patients with TB 10.2-14.4 and > 14.4 μmol/L had a lower incidence of PMI [TB 10.2-14.4 μmol/L: Odds ratio (OR): 0.854; 95% confidence interval (CI): 0.739-0.987; P = 0.032; TB > 14.4 μmol/L: OR: 0.846; 95%CI: 0.735-0.975; P = 0.021] compared with patients with TB < 10.2 μmol/L. Construction of a Kaplan-Meier curve demonstrated a higher MACE-free survival time for patients with higher TB than for those with lower TB (log-rank P = 0.022). After adjustment for cardiovascular risk factors and angiographic characteristics, multivariate Cox analysis showed that a TB level > 14.4 μmol/L was associated with a reduced risk of MACEs compared with a TB level < 10.2 μmol/L (hazard ratio 0. 667; 95%CI: 0.485-0.918; P = 0.013).

CONCLUSION

Bilirubin was a protective factor in PMI prediction. For post-PMI patients, elevated bilirubin levels were independently associated with a reduced risk of MACEs during long-term follow-up.

Keywords: Bilirubin; Perioperative myocardial infarction; Percutaneous coronary intervention; Major adverse cardiovascular events; Coronary heart disease; Retrospective cohort study

Core Tip: Perioperative myocardial infarction (PMI) is a frequent complication of percutaneous coronary intervention, with an adverse long-term outcome. Previous studies have sought to identify potential targets for PMI avoidance. The current study was designed to explore the effect of bilirubin on PMI and its utility for long-term prognosis. Bilirubin has a protective effect making it a suitable predictor of PMI. Furthermore, elevated levels of bilirubin are associated with a reduced risk of major adverse cardiovascular events during long-term follow-up of post-PMI patients. We present evidence of the suitability of bilirubin as a therapeutic target for PMI prevention and other oxidative diseases.