Department of Cardiovascular Medicine, the First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
Department of Cardiovascular Medicine, the First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China; Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, Shaanxi, China.
Am J Cardiol. 2019 Apr 15;123(8):1244-1248. doi: 10.1016/j.amjcard.2019.01.019. Epub 2019 Jan 25.
Bilirubin is known as an antioxidant. However, there have been controversies over whether bilirubin is protective against cardiovascular disease or not. In addition, no study has examined the association between subtypes of total bilirubin (direct bilirubin [DB] and indirect bilirubin [IDB]) and long-term outcomes of acute coronary syndrome (ACS) patients. We included 533 consecutive patients with ACS. All the patients were followed up for the composite end point of cardiac death, revascularization, and acute heart failure. At a median follow-up of 2.4 years, Kaplan-Meier curve demonstrated that higher serum DB levels were significantly associated with major adverse cardiac events (MACE) (p <0.05). However, total bilirubin (TB) and IDB were not associated with MACE by Kaplan-Meier analysis. Cox analysis showed that high TB and DB were associated with increased risk of MACE in ACS even after adjustment of cardiovascular risk factors. The receiver operating characteristic curve illustrated that DB had a predictive value of MACE in ACS. In conclusion, we firstly reported that high TB and DB but not IDB were associated with increased risk of MACE in Chinese ACS, and the prognostic value of DB was superior to that of TB or IDB.
胆红素是一种抗氧化剂。然而，关于胆红素是否对心血管疾病有保护作用一直存在争议。此外，尚无研究探讨总胆红素（直接胆红素[DB]和间接胆红素[IDB]）的亚型与急性冠状动脉综合征（ACS）患者的长期预后之间的关系。我们纳入了 533 例连续的 ACS 患者。所有患者均接受随访，观察终点为心脏死亡、血运重建和急性心力衰竭组成的复合终点事件。中位随访 2.4 年后，Kaplan-Meier 曲线表明较高的血清 DB 水平与主要不良心脏事件（MACE）显著相关（p<0.05）。然而，Kaplan-Meier 分析显示 TB 和 IDB 与 MACE 无相关性。Cox 分析表明，即使调整了心血管危险因素，高 TB 和 DB 与 ACS 患者的 MACE 风险增加相关。受试者工作特征曲线表明 DB 对 ACS 患者的 MACE 有预测价值。总之，我们首次报道在中国 ACS 患者中，高 TB 和 DB 但非 IDB 与 MACE 风险增加相关，且 DB 的预后价值优于 TB 或 IDB。
