A novel predictor of infarct-related artery patency before percutaneous intervention and in-hospital outcomes for ST-segment elevation myocardial infarction patients: serum bilirubin level

Introduction: Previous studies have reported a relationship between serum bilirubin levels and coronary artery disease (CAD). However, data are rare up to now regarding the relation of bilirubin levels with infarct-related artery (IRA) patency in the setting of ST-segment elevation myocardial infarction (STEMI). Moreover, previous studies reported that increased bilirubin was related to impaired post-intervention coronary flow. To our knowledge, the association between serum total bilirubin (TB) levels and pre-primary percutaneous coronary intervention (PCl) with patency of IRA flow in STEMI patients has not been investigated. Aim: To evaluate the association of TB with pre-primary PCl, coronary flow and in-hospital major adverse cardiac events (MACE) in patients with STEMI. Material and methods: A total of 360 consecutive patients with STEMI (mean age = 61.4+/-13.7 years) admitted within 12 h from the time of symptom onset were enrolled. Patients were divided into 2 groups based on the serum TB levels. We defined normal flow as pre-PCl TIMI 3 flow, while impaired flow was defined as pre-PCl TIMI 2 flow. Results: Pre-PCl impaired flow was higher in the TB group than pre-PCl normal flow (p < 0.001). In-hospital mortality and MACE were significantly higher in the high TB group (p = 0.002, p < 0.001 respectively). In the receiver operating characteristic curve analysis, TB > 0.825 mg/dl predicted impaired IRA flow before p-PCl with a sensitivity of 79% and specificity of 71%. Conclusions: The TB is an inexpensive and readily available marker for STEMI patients undergoing PCl. It can be used for risk stratification in this patient population.