title: Initial Total Bilirubin and Clinical Outcome in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention With Drug-Eluting Stents.
abstract: BACKGROUND
  Total bilirubin (TB) concentration is inversely associated with stable coronary artery disease, but there have been few studies on initial TB in patients with ST-segment elevation myocardial infarction (STEMI).
  
  
  RESULTS
  A total of 1,111 consecutive patients with STEMI undergoing primary percutaneous coronary intervention (PCI) with drug-eluting stents (DES) were divided into a high TB group (n=295) and a low TB group (n=816) according to the optimal cut-off 0.79 mg/dl. The high TB group had a higher rate of in-hospital major adverse cardiac events (MACE), a composite of cardiac death, non-fatal MI, and definite/probable stent thrombosis (14.2% vs. 4.2%, P<0.001) and cardiac death (13.9% vs. 3.9%, P<0.001) compared with the low TB group. The 30-day MACE-free survival rate was also significantly different between the groups (P<0.001, log-rank test). On multivariate Cox regression, initial high TB was a significant predictor of in-hospital MACE (HR, 2.69; 95% CI: 1.67-4.34, P=0.010) and of cardiac death (HR 2.72, 95% CI: 1.67-4.44, P=0.012). Adding initial TB to TIMI risk score significantly improved prediction for in-hospital MACE according to net reclassification improvement (NRI=5.2%, P=0.040) and integrated discrimination improvement (IDI=0.027, P=0.006).
  
  
  CONCLUSIONS
  Initial TB is a powerful prognostic marker, and inclusion of this can improve prediction of in-hospital MACE in patients with STEMI undergoing primary PCI with DES. (Circ J 2016; 80: 1437-1444).
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital.
authors.forename: Sang-Ryul
authors.initials: SR
authors.lastname: Chung
authors.forename: Tae-Hyun
authors.initials: TH
authors.lastname: Yang
authors.forename: Ho-Cheol
authors.initials: HC
authors.lastname: Shin
authors.forename: Han-Young
authors.initials: HY
authors.lastname: Jin
authors.forename: Jeong-Sook
authors.initials: JS
authors.lastname: Seo
authors.forename: Jae-Sik
authors.initials: JS
authors.lastname: Jang
authors.forename: Dae-Kyeong
authors.initials: DK
authors.lastname: Kim
authors.forename: Dong-Soo
authors.initials: DS
authors.lastname: Kim
authors.forename: Gwang-Won
authors.initials: GW
authors.lastname: Seo
authors.forename: Pil-Sang
authors.initials: PS
authors.lastname: Song
authors.forename: Dong-Kie
authors.initials: DK
authors.lastname: Kim
authors.forename: Ki-Hun
authors.initials: KH
authors.lastname: Kim
authors.forename: Sang-Hoon
authors.initials: SH
authors.lastname: Seol
authors.forename: Doo-Il
authors.initials: DI
authors.lastname: Kim
authors.forename: Yun-Kyeong
authors.initials: YK
authors.lastname: Cho
authors.forename: Hyuk-Joon
authors.initials: HJ
authors.lastname: Yoon
authors.forename: Chang-Wook
authors.initials: CW
authors.lastname: Nam
authors.forename: Seung-Ho
authors.initials: SH
authors.lastname: Hur
authors.forename: Ung
authors.initials: U
authors.lastname: Kim
authors.forename: Jong-Seon
authors.initials: JS
authors.lastname: Park
authors.forename: Young-Jo
authors.initials: YJ
authors.lastname: Kim
mesh_terms: D000368:Aged; D001663:Bilirubin / Q000032:analysis*; D015415:Biomarkers / Q000032:analysis; D015331:Cohort Studies; D018572:Disease-Free Survival; D054855:Drug-Eluting Stents; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001663:Bilirubin