Elevated Serum Total Bilirubin Might Indicate Poor Coronary Conditions for Unstable Angina Pectoris Patients beyond as a Cardiovascular Protector

Q: What are the key findings of this study?

Elevated serum total bilirubin was associated with a two-fold higher risk of 1-year adverse cardiac events in unstable angina patients.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Unstable angina pectoris (UAP) (n=296). Intervention: Elevated serum total bilirubin (STB >=21.7 umol/L) vs. Low serum total bilirubin (STB <21.7 umol/L). Primary outcome: 1-year adverse cardiac events (composite of all-cause death, nonfatal myocardial infarction, and ischemic rehospitalization) (HR 2.01, 95% CI 1.05-3.84, p=<0.01).

Q: What does this research mean for the field?

Elevated serum total bilirubin (≥21.7 μmol/L) is associated with severe coronary lesion complexity, coronary slow flow, and a two-fold increased risk of 1-year adverse cardiac events in unstable angina pectoris patients. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To investigate whether elevated serum total bilirubin reflects coronary lesion severity, slow coronary flow, and clinical prognosis in patients with unstable angina pectoris.

Liang Qi; Yongjian Zhang; Jin Hua Liang

doi:10.1155/2023/5532917

September 5, 2023Cardiovascular TherapeuticsOpen Access

Elevated Serum Total Bilirubin Might Indicate Poor Coronary Conditions for Unstable Angina Pectoris Patients beyond as a Cardiovascular Protector

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Key result

Elevated serum total bilirubin linked to ~2-fold higher 1-year adverse cardiac events in unstable angina.

HR 2.01
95% CI 1.05-3.84
P<0.01
n=296

Why the study?

Although serum total bilirubin (STB) is regarded as an antioxidant with vascular protective effects, elevated STB was observed in unstable angina pectoris (UAP) patients with diffused coronary lesions, and the role of STB in UAP patients had not been reported.

Key Points

To investigate whether elevated serum total bilirubin reflects coronary lesion severity, slow coronary flow, and clinical prognosis in patients with unstable angina pectoris.
Retrospectively analyzed 296 enrolled patients with unstable angina pectoris (from 1,120 screened) stratified by Canadian Cardiovascular Society angina grades.
Assessed coronary lesion complexity using the SYNTAX score and coronary microvascular perfusion using corrected thrombolysis in myocardial infarction flow count.
Evaluated coronary slow flow discrimination via receiver operating characteristic analysis and assessed 1-year event-free survival using Kaplan-Meier and multivariable Cox regression analyses.
Multivariable linear regression identified serum total bilirubin (B = 0.59, 95% CI: 0.39-0.74, P < 0.01) and mean platelet volume (B = 0.86, 95% CI: 0.42-1.31, P < 0.01) as independent indicators of SYNTAX score changes.
A serum total bilirubin level ≥21.7 μmol/L identified coronary slow flow with an area under the curve of 0.88 (95% CI: 0.84-0.93, P < 0.01).
Patients with serum total bilirubin ≥21.7 μmol/L experienced lower event-free survival (log-rank χ² = 4.75, P < 0.05) and an increased risk of 1-year poor outcomes (HR: 2.01, 95% CI: 1.06-3.84, P < 0.01).

Study Design

Type

Cohort (n=296)

Multicenter

No

PICO

P

Population

296 adult patients (>18 and <80 years old) with unstable angina pectoris undergoing coronary angiography, free of hepatobiliary or renal dysfunction, followed for 1 year.

E

Exposure / Comparator

Elevated serum total bilirubin (STB >=21.7 umol/L) vs Low serum total bilirubin (STB <21.7 umol/L)

O

Primary Outcome

1-year adverse cardiac events (composite of all-cause death, nonfatal myocardial infarction, and ischemic rehospitalization) — HR 2.01 (1.05-3.84), p=<0.01

Main Result

Hazard Ratio: 2.01 (95% CI 1.05–3.84)

p-value: p=<0.01

Limitations

Single-center retrospective design
Relatively small number of cardiac events requiring validation in larger studies
Lack of genetic testing to definitively exclude Gilbert syndrome
The STB cut-off value requires confirmation in multicenter investigations

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Should not alter unstable angina management; challenges prior evidence linking low bilirubin to higher cardiovascular risk.

Abstract

Backgrounds. Serum total bilirubin (STB) is recently more regarded as an antioxidant with vascular protective effects. However, we noticed that elevated STB appeared in unstable angina pectoris (UAP) patients with diffused coronary lesions. We aimed to explore STB’s roles in UAP patients, which have not been reported by articles. Methods and Results. 1120 UAP patients were retrospectively screened, and 296 patients were finally enrolled. They were grouped by Canadian Cardiovascular Society (CCS) angina grades. The synergy between PCI with TAXUS stent and cardiac surgery score (SYNTAX score) and corrected thrombolysis in myocardial infarction flow count (CTFC) were adopted to profile coronary features. The results showed that STB, mean platelet volume (MPV), hs-CRP, fasting blood glucose (FBG), red blood cell width (RDW), and CTFC elevated significantly in the CCS high-risk group. STB ( B = 0.59 , 95% CI: 0.39-0.74, P < 0.01 ) and MPV ( B = 0.86 , 95% CI: 0.42-1.31, P < 0.01 ) could indicate SYNTAX score changes for these patients. STB (≥21.7 μmol/L) could even indicate a coronary slow flow condition (AUC: 0.88, 95% CI: 0.84-0.93, P < 0.01 ). Moreover, UAP patients with elevated STB had a lower event-free survival rate by the Kaplan-Meier curve. STB ≥21.7 μmol/L could reflect a poor coronary flow status and indicate 1-year poor outcomes for these patients (HR: 2.01, 95% CI: 1.06-3.84, P < 0.01 ). Conclusion. Elevated STB in UAP patients has a close relationship with changes in SYNTAX score. STB (over 21.7 μmol/L) could even indicate a coronary slow flow condition and poor outcomes for the UAP patients.

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Cite This Study

Qi et al. (2023) conducted a cohort in Unstable angina pectoris (UAP) (n=296). Elevated serum total bilirubin (STB >=21.7 umol/L) vs. Low serum total bilirubin (STB <21.7 umol/L) was evaluated on 1-year adverse cardiac events (composite of all-cause death, nonfatal myocardial infarction, and ischemic rehospitalization) (HR 2.01, 95% CI 1.05-3.84, p=<0.01). Elevated serum total bilirubin was associated with a two-fold higher risk of 1-year adverse cardiac events in unstable angina patients.

synapsesocial.com/papers/6ae1aff2f2e9d9a2db12612d https://doi.org/10.1155/2023/5532917

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Elevated Serum Total Bilirubin Might Indicate Poor Coronary Conditions for Unstable Angina Pectoris Patients beyond as a Cardiovascular Protector

Key Points

Study Design

PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Elevated Serum Total Bilirubin Might Indicate Poor Coronary Conditions for Unstable Angina Pectoris Patients beyond as a Cardiovascular Protector

Key Points

Study Design

PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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