Correlation between Serum Bilirubin and Recurrent Coronary Events in Patients after Coronary Artery Stent Implantation_Chinese Journal of Evidence-Based Medicine

Authors：

 LUOCheng-feng , CAIRen-jie , LIAi-qun , CHENGChuan-fang , HUANGHe , LINXiao-zhen , MOPei , LIGuo-qiang , LIXiao-yun ,  XIONGLong-gen

Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Cardiovascular Disease, Guangzhou 510260, China;

Corresponding author：

XIONGLong-gen, Email: xionglg66@126.com

Keywords：

Coronary artery disease; Coronary artery stent implantation; Bilirubin; Risk factor

DOI：

10.7507/1672-2531.20140150

Video：

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Objective To investigate the factors related to recurrent coronary events in patients after coronary artery stent implantation. Methods We retrospectively studied the patients performing coronary angiography (CAG) who were admitted to the Department of Cardiology of the Second Affiliated Hospital of Guangzhou Medical University between January 2012 and June 2013. All of the enrolled patients had received CAG in our hospital, with complete coronary angiogram and clinical data. The patients were divided into two groups according to the coronary angiogram and clinical data: coronary event group and non-coronary event group. SPSS 16.0 software was employed for statistical analysis, and multivariate analysis was performed using binary logistic regression model to analyze the risk factors. Results A total of 115 patients were included, of which 50 patients had recurrent coronary events. Both the serum total bilirubin and unconjugated bilirubin in patients with coronary events were significantly lower compared with the patients without coronary events at baseline and at the time of CAG reexamination (P < 0.05 or P < 0.01). The serum total bilirubin at baseline and the serum total bilirubin and unconjugated bilirubin at the time of CAG reexamination were significantly lower in patients with revasculization due to the progression of coronary artery lesions compared with the patients without coronary events (P < 0.05 or P < 0.01). The serum unconjugated bilirubin in patients with in-stent restenosis were significantly lower compared with the patients without coronary events at baseline and at the time of CAG reexamination (P < 0.05). The results of logistic regression analysis showed that multi-vessel coronary artery disease (two-vessel coronary artery disease: OR=10.094, 95%CI 2.498 to 40.798, P=0.001; three-vessel coronary artery disease: OR=16.047, 95%CI 4.121 to 62.481, P=0.000) and low serum unconjugated bilirubin (OR=0.873, 95%CI 0.773 to 0.987, P=0.03) were independent risk factors of recurrent coronary events. Conclusion Multi-vessel coronary artery disease and low serum unconjugated bilirubin are independent risk factors of recurrent coronary events in patients after coronary artery stent implantation.

Citation： LUOCheng-feng, CAIRen-jie, LIAi-qun, CHENGChuan-fang, HUANGHe, LINXiao-zhen, MOPei, LIGuo-qiang, LIXiao-yun, XIONGLong-gen. Correlation between Serum Bilirubin and Recurrent Coronary Events in Patients after Coronary Artery Stent Implantation. Chinese Journal of Evidence-Based Medicine, 2014, 14(8): 905-910. doi: 10.7507/1672-2531.20140150 Copy

1.	Hamm CW, Bassand JP, Agewall S, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J, 2011, 32(23): 2999-3054.
2.	Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. Eur Heart J, 2012, 33(20): 2551-2567.
3.	Vitek L, Jirsa M, Brodanova M, et al. Gilbert syndrome and ischemic heart disease: a protective effect of elevated bilirubin levels. Atherosclerosis, 2002, 160(2): 449-456.
4.	Vitek L, Schwertner HA. The heme catabolic pathway and its protective effects on oxidative stress-mediated diseases. Adv Clin Chem, 2007, 43: 1-57.
5.	Novotný L, Vítek L. Inverse relationship between serum bilirubin and atherosclerosis in men: a meta-analysis of published studies. Exp Biol Med (Maywood), 2003, 228(5): 568-571.
6.	Lin JP, Vitek L, Schwertner HA. Serum bilirubin and genes controlling bilirubin concentrations as biomarkers for cardiovascular disease. Clin Chem, 2010, 56(10): 1535-1543.
7.	Canpolat U, Aytemir K, Yorgun H, et al. Association of serum total bilirubin levels with the severity, extent and subtypes of coronary atherosclerotic plaques detected by coronary CT angiography. Int J Cardiovasc Imaging, 2013, 29(6): 1371-1379.
8.	史连义, 周志伟, 田雪梅, 等.冠心病患者血清总胆红素水平的meta分析.中国老年学杂志, 2012, 32(4): 1368-1370.
9.	Gullu H, Erdogan D, Tok D, et al. High serum bilirubin concentrations preserve coronary flow reserve and coronary microvascular functions. Arterioscler Thromb Vasc Biol, 2005, 25(11): 2289-2294.
10.	Wei S, Mao L, Liu B, et al. Serum biomarkers and the prognosis of AMI patients. Herz, 2014, 39(3): 384-389.
11.	Kuwano T, Miura S, Shirai K, et al. Serum levels of bilirubin as an independent predictor of coronary in-stent restenosis: a new look at an old molecule. J Atheroscler Thromb, 2011, 18(7): 574-583.
12.	田刚, 张春晓, 孙中华, 等.冠状动脉支架置人术后支架内再狭窄的相关因素分析.山东医药, 2012, 52(34): 53-55.
13.	Wu TW, Fung KP, Yang CC. Unconjugated bilirubin inhibits the oxidation of human low density lipoprotein better than Trolox. Life Sci, 1994, 54(25): P477-P481.
14.	Wu TW, Fung KP, Wu J, et al. Antioxidation of human low density lipoprotein by unconjugated and conjugated bilirubins. Biochem Pharmacol, 1996, 51(6): 859-862.
15.	Boon AC, Hawkins CL, Bisht K, et al. Reduced circulating oxidized LDL is associated with hypocholesterolemia and enhanced thiol status in Gilbert syndrome. Free Radic Biol Med, 2012, 52(10): 2120-2127.
16.	Yoshino S, Hamasaki S, Ishida S, et al. Relationship between bilirubin concentration, coronary endothelial function, and inflammatory stress in overweight patients. J Atheroscler Thromb, 2011, 18(5): 403-412.
17.	Kamisako T, Masuda S, Tanaka Y. Relationship between serum bilirubin and remnant lipoprotein cholesterol level. Clin Lab, 2013, 59(3-4): 435-438.
18.	McConnell KJ, Olson KL, Delate T, et al. Factors associated with recurrent coronary events among patients with cardiovascular disease. Pharmacotherapy, 2009, 29(8): 906-913.
19.	Dudnik LB, Azyzova OA, Solovyova NP, et al. Primary biliary cirrhosis and coronary atherosclerosis: protective antioxidant effect of bilirubin. Bull Exp Biol Med, 2008, 145(1): 18-22.

1. Hamm CW, Bassand JP, Agewall S, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J, 2011, 32(23): 2999-3054.
2. Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. Eur Heart J, 2012, 33(20): 2551-2567.
3. Vitek L, Jirsa M, Brodanova M, et al. Gilbert syndrome and ischemic heart disease: a protective effect of elevated bilirubin levels. Atherosclerosis, 2002, 160(2): 449-456.
4. Vitek L, Schwertner HA. The heme catabolic pathway and its protective effects on oxidative stress-mediated diseases. Adv Clin Chem, 2007, 43: 1-57.
5. Novotný L, Vítek L. Inverse relationship between serum bilirubin and atherosclerosis in men: a meta-analysis of published studies. Exp Biol Med (Maywood), 2003, 228(5): 568-571.
6. Lin JP, Vitek L, Schwertner HA. Serum bilirubin and genes controlling bilirubin concentrations as biomarkers for cardiovascular disease. Clin Chem, 2010, 56(10): 1535-1543.
7. Canpolat U, Aytemir K, Yorgun H, et al. Association of serum total bilirubin levels with the severity, extent and subtypes of coronary atherosclerotic plaques detected by coronary CT angiography. Int J Cardiovasc Imaging, 2013, 29(6): 1371-1379.
8. 史连义, 周志伟, 田雪梅, 等.冠心病患者血清总胆红素水平的meta分析.中国老年学杂志, 2012, 32(4): 1368-1370.
9. Gullu H, Erdogan D, Tok D, et al. High serum bilirubin concentrations preserve coronary flow reserve and coronary microvascular functions. Arterioscler Thromb Vasc Biol, 2005, 25(11): 2289-2294.
10. Wei S, Mao L, Liu B, et al. Serum biomarkers and the prognosis of AMI patients. Herz, 2014, 39(3): 384-389.
11. Kuwano T, Miura S, Shirai K, et al. Serum levels of bilirubin as an independent predictor of coronary in-stent restenosis: a new look at an old molecule. J Atheroscler Thromb, 2011, 18(7): 574-583.
12. 田刚, 张春晓, 孙中华, 等.冠状动脉支架置人术后支架内再狭窄的相关因素分析.山东医药, 2012, 52(34): 53-55.
13. Wu TW, Fung KP, Yang CC. Unconjugated bilirubin inhibits the oxidation of human low density lipoprotein better than Trolox. Life Sci, 1994, 54(25): P477-P481.
14. Wu TW, Fung KP, Wu J, et al. Antioxidation of human low density lipoprotein by unconjugated and conjugated bilirubins. Biochem Pharmacol, 1996, 51(6): 859-862.
15. Boon AC, Hawkins CL, Bisht K, et al. Reduced circulating oxidized LDL is associated with hypocholesterolemia and enhanced thiol status in Gilbert syndrome. Free Radic Biol Med, 2012, 52(10): 2120-2127.
16. Yoshino S, Hamasaki S, Ishida S, et al. Relationship between bilirubin concentration, coronary endothelial function, and inflammatory stress in overweight patients. J Atheroscler Thromb, 2011, 18(5): 403-412.
17. Kamisako T, Masuda S, Tanaka Y. Relationship between serum bilirubin and remnant lipoprotein cholesterol level. Clin Lab, 2013, 59(3-4): 435-438.
18. McConnell KJ, Olson KL, Delate T, et al. Factors associated with recurrent coronary events among patients with cardiovascular disease. Pharmacotherapy, 2009, 29(8): 906-913.
19. Dudnik LB, Azyzova OA, Solovyova NP, et al. Primary biliary cirrhosis and coronary atherosclerosis: protective antioxidant effect of bilirubin. Bull Exp Biol Med, 2008, 145(1): 18-22.

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Correlation between Serum Bilirubin and Recurrent Coronary Events in Patients after Coronary Artery Stent Implantation

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