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Serum total bilirubin levels and disease severity in patients with stable coronary artery disease

Gesamtbilirubin-Serumspiegel und Krankheitsschwere bei Patienten mit stabiler Angina pectoris

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Abstract

Aim

Serum total bilirubin (STB), a protective cardiovascular factor, was retrospectively investigated to determine the relationship between STB levels and the severity of disease in Chinese patients with stable coronary artery disease (CAD).

Patients and methods

A total of 347 eligible patients presenting to our department from December 2007 to December 2012 were divided into tertiles according to their Syntax scores (low, moderate, and high). To clarify the association between STB levels and major adverse cardiovascular events (MACE), all patients were divided into two groups according to the median baseline STB (greater than or less than 13.2 μmol/l), which was measured after at least 12-h fast. All participants were followed for a mean of 37.1 months for MACE, including all-cause death, recurrent nonfatal myocardial infarction, and recurrent percutaneous coronary intervention.

Results

The STB levels were significantly lower in the high Syntax score group than those of the other groups and were negatively correlated with the Syntax score and number of diseased vessels. Follow-up data showed a higher incidence of MACE in the low STB group compared with the high STB group. Elevated STB levels predict the long-term prognosis of patients with stable angina pectoris. Finally, Kaplan–Meier analysis showed a significantly higher event-free survival rate in the patients with high STB levels than those in the low STB group.

Conclusions

STB levels were independently associated with the severity of disease in patients with stable CAD. Elevated STB is associated with cardiovascular events and may be useful as a biomarker of the severity and prognosis of stable CAD.

Zusammenfassung

Ziel

Das Serum-Gesamtbilirubin (STB), ein protektiver kardiovaskulärer Faktor, wurde retrospektiv untersucht, um die Beziehung zwischen STB-Werten und der Krankheitsschwere bei chinesischen Patienten mit stabiler Angina pectoris zu bestimmen.

Patienten und Methoden

Insgesamt 347 geeignete Patienten, die sich von Dezember 2007 bis Dezember 2012 in unserer Abteilung vorstellten, wurden nach ihren Syntax-Scores (niedrig, moderat und hoch) in Terzilen eingeteilt. Um die Beziehung zwischen den STB-Werten und schweren unerwünschten kardiovaskulären Ereignissen („major adverse cardiovascular events“, MACE) zu klären, wurden alle Patienten nach ihrem medianen Baseline-STB (größer als oder kleiner als 13,2 μmol/l) eingeteilt, welcher nach mindestens 12 h Nüchternheit gemessen wurde. Alle Teilnehmer wurden für durchschnittlich 37,1 Monate bezüglich MACE nachbeobachtet, einschließlich Tod jeglicher Ursache, rezidivierendem nichttödlichem Myokardinfarkt und wiederholter perkutaner koronarer Intervention.

Ergebnisse

Die STB-Werte waren in der hohen Syntax-Score-Gruppe signifikant niedriger als in den anderen Gruppen und korrelierten negativ mit dem Syntax-Score und der Anzahl der erkrankten Gefäße. Die Follow-up-Daten zeigten eine höhere Inzidenz von MACE bei der niedrigen STB-Gruppe im Vergleich zur hohen STB-Gruppe. Erhöhte STB-Werte stellen einen Prädiktor für die Langzeitprognose von Patienten mit stabiler Angina pectoris dar. Abschließend zeigte die Kaplan-Meier-Analyse eine signifikant höhere ereignisfreie Überlebensrate bei Patienten mit hohen STB-Werten als bei Patienten mit niedrigen STB-Werten.

Schlussfolgerung

Die STB-Werte wurden bei Patienten mit stabiler Angina pectoris unabhängig mit der Krankheitsschwere assoziiert. Ein erhöhter STB-Wert ist mit kardiovaskulären Ereignissen assoziiert und kann als Biomarker für die Krankheitsschwere und die Prognose einer stabilen Angina pectoris von Nutzen sein.

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Acknowledgements

We would like to thank all the staff and participants for their contribution in the study. This work was supported by grants from the Navigator Foundation (No.LHJJ20140610), the Beijing Lisheng Cardiovascular Health Foundation to Jie Yu.

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Authors and Affiliations

  1. Department of Cardiology, Peking University Third Hospital; Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Ministry of Health; Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, 100191, Beijing, China

    J. Yu, J.-L. Han, G.-S. Wang, L.-J. Guo & W. Gao

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  1. J. Yu
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  2. J.-L. Han
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  3. G.-S. Wang
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Correspondence to J.-L. Han.

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Conflict of interest

Jie Yu, Jiang-Li Han, Gui-Song Wang, Li-Jun Guo, and Wei Gao declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

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Yu, J., Han, JL., Wang, GS. et al. Serum total bilirubin levels and disease severity in patients with stable coronary artery disease. Herz 42, 403–410 (2017). https://doi.org/10.1007/s00059-016-4476-7

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