| Background and Objective:Coronary heart disease(CHD) is a high morbidity and mortality disease, and seriously threats to humans health and safety. CHD includes acute coronary syndrome(ACS) and chronic ischemic syndrome. ACS is a clinical type of CHD with acute onset. The main reason of this disease due to that activation of inflammation and oxidative stress leads to vascular endothelial injury in coronary, forms unstable plaque, then that vascular occurs spasm, unstable plaque cracked, thrombosis lead to acute cardiac ischemia. ACS includes ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction(NSTEMI) and unstable angina(UA). Myocardial revascularization is one of the key methods for ACS treatment. The methods including thrombolytic therapy, percutaneous coronary intervention(PCI) and coronary artery bypass grafting(CABG). Evidence-based medicine confirms that PCI is an important measure for treatment of coronary heart disease, which can save the patient’s life, prolong patient’s life and improve patient’s quality of life. However, repeat revascularization is still a major problem in patients after PCI. The main problem is the risk stratification for PCI in patients with treatment, and finding the perfect indicators to assess the outcome for prevention. Prognosis of patients with PCI therapy is traditional judged mostly according to gender, age, number of stents, the length of stents, history of hypertension and diabetes mellitus.Serum total bilirubin (STB) is a metabolic product of heme catabolism.80%of bilirubin is generated from hemoglobin by the catalytic reduction of rate-limiting enzyme heme oxygenase (HO), and about15%to20%of STB comes from nonhemoglobin or hemoglobin of ineffective hematopoiesis. HO breaks down the heme into biliverdin, carbon monoxide, and free iron. Then biliverdin is changed into STB by the activity of bilirubin reductase. The above-mentioned was indirect bilirubin (IBIL), IBIL with albumin as carrier flowed into the liver after the formation with the blood, and then formed direct bilirubin (DBIL) after the liver metabolism. STB was the index that was used to diagnose whether has hemolytic or to judge the functional status of gastrointestinal and hepatobiliary system in bile pigment metabolism. Early studies from Chinese medical workers at home and abroad showed that STB levels was negative with incidence of coronary heart disease, STB levels declined50%, and the risk of coronary heart disease increased47%. But the relationship between STB levels and prognosis in patients with ACS after PCI is not clear. The aim of this study was to assess the relationship between the level of STB and the prognosis of ACS patients after PCI.Method:A total of1273consecutive patients who undergoing PCI in cardiology department, First affiliated hospital of Zhengzhou University from July2009to December2010were enrolled in this study. Patient’s fasting STB concentrations within24h after admission and other relevant clinical data were recorded. The patients were followed-up by telephone or out-patient clinics from August to November,2012. All endpoints were recorded. The primary endpoint was death of all cause. The secondary endpoints were acute myocardial infarction, PCI or CABG, readmission for angina pectoris, heart failure or stroke. The patients were divided into four groups according to STB:the low STB group (G1:STB<3.4umol/L), the low-normal STB group (G2:3.4umol/L<STB≤10.3umol/L), the high-normal STB group (G3:10.3umol/L<STB≤17.1umol/L) and the high STB group (G4:STB>17.1umol/L). Application of univariate and multivariate logistic regression analyses to explore factors associated with the prognosis. The survival rate was estimated using Kaplan-Meier survival curve. P<0.05was considered as statistically significant difference.Results:1.1152patients (90.5%) were successfully followed-up. Mean follow-up time were (30.4±5.0) months.187patients experienced endpoints (16.2%), and45patients died (3.9%).2. Univariate analysis showed that the patients with endpoints tended to have a low level of STB or higher prevalence of diabetes, hypertension, had higher left ventricular end-diastolic volume (LVEDV) and systolic blood pressure (SBP), more number of coronary lesions than patients without endpoints, treated with aspirin and clopidogrel less than1year, without treated with ACEI/ARB, β-blocker, or statins (P <0.05).3. The mean level of STB in patients with and without endpoints were8.37±4.09umol/L and10.42±5.29umol/L, respectively. The mean level of STB in male and female were9.23±4.76umol/L and10.50±5.30umol/L, respectively. And, the mean level in patients without diabetes mellitus and with hyperglycemia were10.23±5.18umol/L and8.75±4.14umol/L, respectively. The difference were statistically significant(P<0.01).4. The level of STB was inversely correlated with triglyeride, low density lipoprotein, or platelet. And, the level of STB was positively correlated to heart rate, alanine aminotransferase, high density lipoprotein, hypersensitive C reactive protein, LVEDV, left ventricular end-systolic volume (LVESV).5. The incidence of total endpoints in the four groups decreased with the increase of STB (28.8%,17.1%,11.2%,8.5%,χ2=22.159, P<0.001). There was no difference about incidence of primary endpoint between4groups(6.6%,4.3%,3.0%,2.8%, χ2 =2.366, P=0.500).6. In a multivariate logistic analysis:①the incidence of total endpoints in G3and G4group were decreased56.4%(OR=0.436,95%CI0.237-0.804, P=0.008) and63.6%(OR=0.364,95%CI0.190-0.695, P=0.002) respectively.②Hypertension was a risk factor of endpoint. The endpoint odds ratio for suboptimal blood pressure control was4.790(95%CI2.166-10.593, P<0.001).③The endpoint odds ratio for oral clopidogrel after PCI less than1year was6.065(95%CI2.894-12.711, P<0.001) compared with oral clopidogrel as required.④Without oral P-blocker is a risk factor of endpoint. The endpoint odds ratio for without β-blocker was1.620(95%CI1.047-2.504, P=0.030).7. Kaplan-Meier survival curve analysis showed that there were significent difference between4groups about cumulative survival rates without endpoints. Log-rank test indicated that the difference was statistically significant (P<0.01).Conclusion:1. Uncontrolled hypertension, oral clopidogrel after PCI less than1year, without oral β-blocker, or low level STB are independent risk factors of endpoints in patients after PCI.2. STB concentration is associated with the endpoints negatively in patients with ACS after PCI. But it is not associated with mortality. |
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