Clinical Medical College, Weifang Medical University, Weifang City, Shandong Province, China; Department of Cardiology, Linyi People's Hospital, Weifang Medical University, Linyi City, Shandong Province, China.
Department of Cardiology, Linyi People's Hospital, Weifang Medical University, Linyi City, Shandong Province, China.
Clinics (Sao Paulo). 2023 Nov 8;78:100306. doi: 10.1016/j.clinsp.2023.100306. eCollection 2023.
To investigate the association between serum bilirubin levels and in-hospital Major Adverse Cardiac Events (MACE) in patients with ST-segment Elevation Myocardial Infarction (STEMI) undergoing primary Percutaneous Coronary Intervention (PCI).
A total of 418 patients with STEMI who underwent primary PCI were enrolled from October 1, 2021 to October 31 2022. The average age of enrolled participants was 59.23 years, and 328 patients (78.50%) were male patients. Patients were divided into MACE (patients with angina pectoris after infarction, recurrent myocardial infarction, acute heart failure, cardiogenic shock, malignant arrhythmias, or death after primary PCI) (n = 98) and non-MACE (n = 320) groups. Univariate and multivariate logistic regression analyses were performed to estimate the association between different bilirubin levels including Total Bilirubin (TB), Direct Bilirubin (DB), Indirect Bilirubin (IDB), and risk of in-hospital MACE. The area under the Receiver Operating Characteristic (ROC) curve was used to determine the accuracy of bilirubin levels in predicting in-hospital MACE.
The incidence of MACE in STEMI patients increased from the lowest to the highest bilirubin tertiles. Multivariate logistic regression analysis showed that increased total bilirubin level was an independent predictor of in-hospital MACE in patients with STEMI (p for trend = 0.02). Compared to the first TB group, the ORs for risk of MACE were 1.58 (95% CI 0.77‒3.26) and 2.28 (95% CI 1.13‒4.59) in the second and third TB groups, respectively. The ROC curve analysis showed that the areas under the curve for TB, DB and IDB in predicting in-hospital MACE were 0.642 (95% CI 0.578‒0.705, p < 0.001), 0.676 (95% CI 0.614‒0.738, p < 0.001), and 0.619 (95% CI 0.554‒0.683, p < 0.001), respectively.
The current study showed that elevated TB, DB, and IDB levels are independent predictors of in-hospital MACE in patients with STEMI after primary PCI, and that DB has a better predictive value than TB and IDB.
探讨血清胆红素水平与接受直接经皮冠状动脉介入治疗（PCI）的 ST 段抬高型心肌梗死（STEMI）患者院内主要不良心脏事件（MACE）的关系。
2021 年 10 月 1 日至 2022 年 10 月 31 日期间，共纳入 418 例接受直接 PCI 的 STEMI 患者。纳入患者的平均年龄为 59.23 岁，328 例（78.50%）为男性患者。根据患者是否发生 MACE（包括梗死后心绞痛、再发心肌梗死、急性心力衰竭、心源性休克、恶性心律失常或初次 PCI 后死亡）分为 MACE 组（n=98）和非 MACE 组（n=320）。采用单因素和多因素 logistic 回归分析评估不同胆红素水平（总胆红素（TB）、直接胆红素（DB）、间接胆红素（IDB））与院内 MACE 风险之间的关系。采用受试者工作特征（ROC）曲线下面积评估胆红素水平预测院内 MACE 的准确性。
随着胆红素三分位值的升高，STEMI 患者的 MACE 发生率逐渐升高。多因素 logistic 回归分析显示，TB 水平升高是 STEMI 患者院内 MACE 的独立预测因素（趋势检验 p=0.02）。与 TB 第 1 组相比，TB 第 2 组和第 3 组发生 MACE 的风险 OR 值分别为 1.58（95%CI：0.77‒3.26）和 2.28（95%CI：1.13‒4.59）。ROC 曲线分析显示，TB、DB 和 IDB 预测院内 MACE 的曲线下面积分别为 0.642（95%CI：0.578‒0.705，p<0.001）、0.676（95%CI：0.614‒0.738，p<0.001）和 0.619（95%CI：0.554‒0.683，p<0.001）。
本研究表明，STEMI 患者直接 PCI 后 TB、DB 和 IDB 水平升高是院内 MACE 的独立预测因素，且 DB 较 TB 和 IDB 具有更好的预测价值。
