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Increased oxidative stress and vascular inflammation are main mechanisms for no reflow onset after acute ST-segment elevation myocardial infarction(STEMI) who were treated by primary percutaneous coronary intervention (PCI). Recent studies have been reported that the concentration of total bilirubin (TB), acted as antioxidant, could preserve coronary flow reserve and coronary microvascular functions and was reversely associated with in hospital outcomes of primary PCI. However, it is not clear whether high TB exert favorable effects on prognosis of no reflow patients during PCI. This study was performed to assess the prognostic role of TB in no reflow patients.
Material and Methods
143 consecutive patients (age: 65.29±12.62 years old) with no reflow treated by primary PCI was enrolled to study. Patients were divided into two groups based on the TB concentrations (0.9 mg/dl). No-reflow was diagnosed using 2 different methods after PCI: TIMI flow Grade≤2 or TIMI flow grade 3 with a TIMI myocardial perfusion grade(TMPG)≤1. All patients were retrospectively followed up for 9 years for the all cause death and cardiac death.
There were 31 all cause deaths during follow-up. Of them, 26 patients died from cardiac cause. Patients with adverse events had lower baseline serum TB levels (P<0.05). All patients were stratified into high TB and low TB groups. The mortality of high TB group is lower than that of low TB group (14.9% vs. 29.0% for all cause death, P=0.038; 9.5% vs. 27.5% for cardiac death, p=0.006). In a multivariate Cox regression analysis,after adjusted for age, left ventricular ejection fraction (LVEF) et al., the patients had the lower incidence of all cause death and cardiac death in the high TB group than that in the low TB group (OR:0.423, 95%CI 0.184-0.975,p=0.043, vs. OR: 0.281, 95%CI 0.103-0.765, P=0.013, respectively).
Serum high TB level on admission is a protective and independent predictor of long term outcomes among no-reflow patients with STEMI undergoing primary PCI. In addition, TB concentrations may be a novel candidate biomarker for stratification of risk in no reflow patients with STEMI during primary PCI.
- 2013 American College of Cardiology Foundation