Key result
High initial total bilirubin linked to ~169% higher in-hospital MACE risk following STEMI primary PCI.
Why the study?
There have been few studies on the prognostic value of initial total bilirubin in patients with STEMI undergoing primary PCI with drug-eluting stents.
Does high initial total bilirubin predict in-hospital MACE in patients with STEMI undergoing primary PCI with DES?
Cohort (n=1,111)
Yes
Does high initial total bilirubin predict in-hospital MACE in patients with STEMI undergoing primary PCI with DES?
Hazard Ratio: 2.69 (95% CI 1.67–4.34)
Absolute Event Rate: 14.2% vs 4.2%
p-value: p=0.010
Initial total bilirubin >0.79 mg/dl is a powerful prognostic marker that improves the prediction of in-hospital MACE when added to the TIMI risk score in STEMI patients undergoing primary PCI.
High initial bilirubin may refine in-hospital MACE prediction in STEMI PCI; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND: Total bilirubin (TB) concentration is inversely associated with stable coronary artery disease, but there have been few studies on initial TB in patients with ST-segment elevation myocardial infarction (STEMI). METHODS AND RESULTS: A total of 1,111 consecutive patients with STEMI undergoing primary percutaneous coronary intervention (PCI) with drug-eluting stents (DES) were divided into a high TB group (n=295) and a low TB group (n=816) according to the optimal cut-off 0.79 mg/dl. The high TB group had a higher rate of in-hospital major adverse cardiac events (MACE), a composite of cardiac death, non-fatal MI, and definite/probable stent thrombosis (14.2% vs. 4.2%, P<0.001) and cardiac death (13.9% vs. 3.9%, P<0.001) compared with the low TB group. The 30-day MACE-free survival rate was also significantly different between the groups (P<0.001, log-rank test). On multivariate Cox regression, initial high TB was a significant predictor of in-hospital MACE (HR, 2.69; 95% CI: 1.67-4.34, P=0.010) and of cardiac death (HR 2.72, 95% CI: 1.67-4.44, P=0.012). Adding initial TB to TIMI risk score significantly improved prediction for in-hospital MACE according to net reclassification improvement (NRI=5.2%, P=0.040) and integrated discrimination improvement (IDI=0.027, P=0.006). CONCLUSIONS: Initial TB is a powerful prognostic marker, and inclusion of this can improve prediction of in-hospital MACE in patients with STEMI undergoing primary PCI with DES. (Circ J 2016; 80: 1437-1444).
No takes yet. Share an insight, caveat, or question.
Chung et al. (2016) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=1,111). Initial high total bilirubin (>0.79 mg/dl) vs. Initial low total bilirubin (≤0.79 mg/dl) was evaluated on In-hospital major adverse cardiac events (MACE) (HR 2.69, 95% CI 1.67-4.34, p=0.010). Initial high total bilirubin (>0.79 mg/dl) was an independent predictor of in-hospital MACE (HR 2.69) in patients with STEMI undergoing primary PCI with drug-eluting stents.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: