Effects of bilirubin on perioperative myocardial infarction and its long-term prognosis in patients undergoing percutaneous coronary intervention

doi:10.12998/wjcc.v10.i6.1775

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World Journal of Clinical Cases

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Retrospective Cohort Study

World J Clin Cases. Feb 26, 2022; 10(6): 1775-1786
Published online Feb 26, 2022. doi: 10.12998/wjcc.v10.i6.1775

Table 1 Baseline demographic, clinical characteristics and angiographic characteristics of the study population (mean ± SD)

Variable	Tertile I < 10.2 μmol/L, n = 3430	Tertile II 10.2-14.4 μmol/L, n = 3405	Tertile III > 14.4 μmol/L, n = 3401	P value (All)	Tertile I vs Tertile II	Tertile I vs Tertile III	Tertile II vs Tertile III
Age (years)	66.9 ± 10.4	66.3 ± 10.3	65.6 ± 10.0	< 0.001	0.020	< 0.001	0.006
Female, n (%)	1232 (36.0)	1017 (29.9)	676 (19.9)	< 0.001	< 0.001	< 0.001	< 0.001
BMI (kg/m²)	24.6 ± 4.9	24.9 ± 11.2	24.9 ± 10.1	0.314	0.063	0.091	0.651
Current smoking, n (%)	774 (22.6)	731 (21.5)	735 (21.6)	0.491	0.401	0.288	0.821
Diabetes, n (%)	1015 (29.6)	848 (24.9)	782 (23.0)	< 0.001	< 0.001	< 0.001	0.028
Hypertension, n (%)	2413 (70.4)	2327 (68.3)	2276 (66.9)	0.008	0.021	< 0.001	0.122
Hyperlipidemia, n (%)	532 (15.5)	557 (16.4)	522 (15.3)	0.470	0.449	0.726	0.266
Prior stroke, n (%)	353 (10.3)	300 (8.8)	253 (7.4)	< 0.001	0.037	< 0.001	0.110
eGFR < 60 (mL/min/1.73 m²), n (%)	488 (14.2)	345 (10.1)	269 (7.9)	< 0.001	< 0.001	< 0.001	< 0.001
LVEF (%)	66.8 ± 8.0	67.2 ± 7.8	67.0 ± 9.0	0.096	0.031	0.575	0.008
Prior MI, n (%)	395 (11.5)	360 (10.6)	399 (11.7)	0.271	0.054	0.861	0.071
Prior PCI, n (%)	876 (25.5)	800 (23.5)	806 (23.7)	0.094	0.052	0.056	0.978
Unstable angina, n (%)	1850 (54.0)	1740 (51.1)	1708 (50.3)	0.006	0.002	< 0.001	0.528
Perioperative medications, n (%)
ACEI/ARB	1979 (57.7)	1916 (56.3)	1825 (53.7)	0.003	0.613	< 0.001	0.021
Beta-blocker	1746 (50.9)	1746 (51.3)	1691 (49.7)	0.407	0.835	0.129	0.082
Calcium-channel blocker	1270 (37.0)	190 (34.9)	1114 (32.8)	0.001	0.004	< 0.001	0.034
LDL-C (mmol/L)	2.05 ± 0.88	2.09 ± 0.86	2.04 ± 0.86	0.053	0.117	0.843	0.076
Lesions in vessels, n (%)
Left main	197 (5.7)	186 (5.5)	180 (5.3)	0.711	0.613	0.578	0.959
Left anterior descending	1828 (53.3)	1848 (54.3)	1837 (54.0)	0.702	0.187	0.321	0.926
Left circumflex	579 (16.9)	524 (15.4)	578 (17.0)	0.136	0.068	0.902	0.051
Right coronary artery	983 (28.7)	994 (29.2)	955 (28.1)	0.597	0.960	0.196	0.184
AHA/ACC classification B₂/C, n (%)	1228 (35.8)	1256 (36.8)	1356 (39.9)	0.002	0.487	< 0.001	0.006
Calcification, n (%)	406 (11.8)	391 (11.5)	390 (11.5)	0.864	0.204	0.485	0.567
FFR/IVUS/OCT, n (%)	357 (10.4)	372 (10.9)	402 (11.8)	0.170	0.496	0.050	0.210
Number of implanted stents, median (IQR)	1 (1-2)	1 (1-2)	1 (1-2)	< 0.001	0.005	0.005	0.133
Mean stent size > 2.5 mm, n (%)	3107 (90.6)	3077 (90.4)	3056 (89.9)	0.606	0.755	0.282	0.464
Balloon pre-dilation, n (%)	3031 (88.4)	2970 (87.2)	2921 (85.9)	0.009	0.039	0.001	0.183
Balloon post-dilation, n (%)	3175 (92.6)	3145 (92.4)	3156 (92.8)	0.793	0.999	0.828	0.827

Data are presented as n or %. ACEI: Angiotensin-Converting Enzyme Inhibitors; AHA/ACC: American Heart Association/American College of Cardiology; ARB: Angiotensin Receptor Blocker; BMI: Body mass index; eGFR: Estimated glomerular filtration rate; FFR: Fractional flow reserve; IVUS: Intravascular ultrasound; LVEF: Left ventricular ejection fraction; MI: Myocardial infarction; OCT: Optical coherence tomography.

Table 2 Factors affecting perioperative myocardial infarction in univariate and multivariate analysis

Variable	Univariate model		Multivariate model
Variable	OR (95%CI)	P value	OR (95%CI)	P value
Age > 65 yr	1.428 (1.268, 1.607)	< 0.001	1.272 (1.110, 1.457)	0.001
Female	1.225 (1.084, 1.384)	0.001	1.200 (1.034, 1.393)	0.017
BMI	0.983 (0.966, 1.000)	0.052
Current smoking	0.832 (0.721, 0.959)	0.011	0.943 (0.797, 1.117)	0.499
Diabetes	1.134 (0.999, 1.287)	0.052
Hypertension	1.271 (1.120, 1.443)	< 0.001	1.054 (0.901, 1.233)	0.509
Prior stroke	1.181 (0.976, 1.428)	0.087
Prior MI	1.309 (1.108, 1.547)	0.002	1.200 (0.991, 1.454)	0.062
eGFR < 60 (mL/min/1.73 m²)	1.645 (1.400, 1.933)	< 0.001	1.369 (1.135, 1.651)	0.001
LVEF	0.975 (0.968, 0.982)	< 0.001	0.980 (0.972, 0.988)	< 0.001
Unstable angina	1.116 (0.996, 1.250)	0.059
Perioperative medications
ACEI/ARB	1.243 (1.107, 1.395)	< 0.001	1.112 (0.965, 1.281)	0.144
Beta-blocker	0.992 (0.886, 1.112)	0.896
Calcium-channel blocker	1.067 (0.948, 1.201)	0.280
LDL-C > 1.8 mmol/L	0.930 (0.808, 1.070)	0.311
AHA/ACC classification B2/C	1.167 (1.040, 1.311)	0.009	1.363 (1.192, 1.558)	< 0.001
Calcification	1.767 (1.514, 2.063)	< 0.001	1.303 (1.091, 1.556)	0.004
FFR/IVUS/OCT	1.391 (1.178, 1.642)	< 0.001	1.275 (1.056, 1.539)	0.011
Number of implanted stents	1.868 (1.741, 2.006)	< 0.001	1.882 (1.738, 2.038)	< 0.001
Mean stent size > 2.5 mm	1.117 (0.917, 1.362)	0.272
Balloon pre-dilation	1.116 (0.937, 1.330)	0.217
Balloon post-dilation	1.330 (0.926, 1.912)	0.123
Total bilirubin
Tertile I	1 (ref)		1 (ref)
Tertile II	0.800 (0.698, 0.918)	0.001	0.854 (0.739, 0.987)	0.032
Tertile III	0.786 (0.685, 0.902)	0.001	0.846 (0.735, 0.975)	0.021

ACEI: Angiotensin-Converting Enzyme Inhibitors; AHA/ACC: American Heart Association/American College of Cardiology; ARB: Angiotensin Receptor Blocker; BMI: Body mass index; eGFR: Estimated glomerular filtration rate; FFR: Fractional flow reserve; IVUS: Intravascular ultrasound; LVEF: Left ventricular ejection fraction; MI: Myocardial infarction; OCT: Optical coherence tomography.

Table 3 Cox proportional hazard regression model: incidence of major adverse cardiac events

Variable	Univariate model		Multivariate model
Variable	HR (95%CI)	P value	HR (95%CI)	P value
Age > 65 yr	1.199 (1.080, 1.332)	0.001	1.123 (1.001, 1.260)	0.048
Male	1.213 (0.921, 1.598)	0.170
BMI	1.005 (0.969, 1.042)	0.782
Current smoking	0.982 (0.733, 1.316)	0.905
Diabetes	1.135 (1.098, 1.173)	< 0.001	1.119 (1.079, 1.161)	< 0.001
Hypertension	1.122 (0.848, 1.484)	0.420
eGFR < 60 (mL/min/1.73 m²)	1.291 (0.936, 1.780)	0.120
LVEF	0.996 (0.984, 1.008)	0.540
Unstable angina	1.284 (1.003, 1.644)	0.048	1.381 (1.071, 1.781)	0.013
LDL-C > 1.8 mmol/L	1.160 (1.650, 1.264)	0.001	1.094 (0.996, 1.201)	0.060
Perioperative medications
ACEI/ARB	1.077 (0.825, 1.405)	0.586
Beta-blocker	1.044 (0.810, 1.345)	0.739
Calcium-channel blocker	1.197 (0.872, 1.644)	0.266
AHA/ACC classification B2/C	0.848 (0.638, 1.128)	0.258
Calcification	1.197 (0.872, 1.644)	0.266
Number of stents implanted	1.186 (1.031, 1.365)	0.017	1.171 (1.012, 1.354)	0.034
Total bilirubin
Tertile I	1 (ref)		1 (ref)
Tertile II	0.801 (0.604, 1.063)	0.125	0.837 (0.627, 1.119)	0.229
Tertile III	0.640 (0.469, 0.875)	0.005	0.667 (0.485, 0.918)	0.013

Table 4 Association between serum total bilirubin and clinical outcomes

Events	Tertile I	Tertile II	Tertile III
Composite MACE¹
Number events/participants	118 (23.2)	81 (19.6)	59 (15.3)
Adjust HR and 95%CI	1.0 (ref)	0.837 (0.627, 1.119)	0.667 (0.485, 0.918)^a
Cardiac death
Number events/participants	27 (5.3)	13 (3.1)	13 (3.4)
Adjust HR and 95%CI	1.0 (ref)	0.546 (0.28, 1.065)	0.588 (0.295, 1.171)
Non-fatal myocardial infarction
Number events/participants	13 (2.6)	11 (2.7)	7 (1.8)
Adjust HR and 95%CI	1.0 (ref)	1.113 (0.487, 2.547)	0.736 (0.286, 1.898)
Non-fatal stroke
Number events/participants	2 (0.4)	2(0.5)	2 (0.5)
Adjust HR and 95%CI	1.0 (ref)	1.534 (0.213, 11.067)	1.888 (0.251, 14.211)
Revascularization²
Number events/participants	84 (16.5)	59 (14.3)	39 (10.1)
Adjust HR and 95%CI	1.0 (ref)	0.814 (0.608, 1.089)	0.633 (0.458, 0.875)^a

¹Major cardiovascular adverse event was defined as a composite of cardiac death, myocardial infarction, stroke and revascularization.

²Adjusted model included age, diabetes, unstable angina, LDL-C and numbers of stents implanted.

^aP < 0.05.

CI: Confidence intervals; HR: Hazard ratio; MACE: Major cardiovascular adverse events.

Citation: Li Y, Li DB, Zhao LD, Lv QB, Wang Y, Ren YF, Zhang WB. Effects of bilirubin on perioperative myocardial infarction and its long-term prognosis in patients undergoing percutaneous coronary intervention. World J Clin Cases 2022; 10(6): 1775-1786
URL: https://www.wjgnet.com/2307-8960/full/v10/i6/1775.htm
DOI: https://dx.doi.org/10.12998/wjcc.v10.i6.1775