Huang Fang-Yang, Peng Yong, Huang Bao-Tao, Yang Yong, Pu Xiao-Bo, Chen Shi-Jian, Gui Yi-Yue, Xia Tian-Li, Chen Fei, Liu Rui-Shuang, Zhu Ye, Chen Mao
Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
Department of General Practice Medicine, West China Hospital, Sichuan University, Chengdu, China.
Clin Chim Acta. 2017 Feb;465:101-105. doi: 10.1016/j.cca.2016.12.020. Epub 2016 Dec 23.
The relation between serum total bilirubin (TBi) and mortality in patients with established coronary artery disease (CAD) remains undefined. We try to investigate the role of the subtypes of CAD in the association.
A total of 3013 patients with angiographically obstructive CAD were enrolled. A retrospective analysis was conducted. Patients were divided into 3 groups as follows: stable CAD (SCAD), unstable angina pectoris (UAP) and acute myocardial infarction (AMI). The predictive values of TBi for 30-day and long-term mortality were assessed using logistic and Cox regression, respectively.
Higher initial serum TBi levels were significantly associated with increased risk of short-term mortality (OR 2.35, 95% CI 1.15-4.77) in AMI group. However, the association was absent among patients with SCAD and UAP. Serum TBi was able to independently predict the long-term mortality in SCAD (HR 0.34, 95% CI 0.16-0.70) and UAP (HR 0.49, 95% CI 0.31-0.78) groups. However, there was no significant relation between TBi and long-term mortality in AMI groups.
The different subtypes of CAD affected the relation between serum TBi and clinical prognosis. Initial serum TBi was positively correlated with short-term mortality of AMI patients, and negatively correlated with long-term mortality in SCAD or UAP patients.
在已确诊的冠状动脉疾病(CAD)患者中,血清总胆红素(TBi)与死亡率之间的关系尚不明确。我们试图研究CAD亚型在这种关联中的作用。
共纳入3013例经血管造影证实为阻塞性CAD的患者。进行回顾性分析。患者分为以下3组:稳定型CAD(SCAD)、不稳定型心绞痛(UAP)和急性心肌梗死(AMI)。分别使用逻辑回归和Cox回归评估TBi对30天和长期死亡率的预测价值。
在AMI组中,较高的初始血清TBi水平与短期死亡风险增加显著相关(OR 2.35,95%CI 1.15 - 4.77)。然而,在SCAD和UAP患者中未发现这种关联。血清TBi能够独立预测SCAD组(HR 0.34,95%CI 0.16 - 0.70)和UAP组(HR 0.49,95%CI 0.31 - 0.78)的长期死亡率。然而,在AMI组中,TBi与长期死亡率之间无显著关系。
CAD的不同亚型影响血清TBi与临床预后之间的关系。初始血清TBi与AMI患者的短期死亡率呈正相关,与SCAD或UAP患者的长期死亡率呈负相关。