China: Higher myocardial infarction admission total bilirubin (TBIL) is an independent predictor of poor prognosis in patients with new-onset non-ST elevation myocardial infarction (NSTEMI), says a recent study.
The findings of the study, published in the journal BMC Cardiovascular Disorders, support the incorporation of serum TBIL measurement while performing risk stratification for patients with new-onset NSTEMI because of the convenience and cost-effectiveness of measuring serum TBIL.

Prior to the study, there was no clear understanding of the potential prognostic role of TBIL in patients with new-onset NSTEMI. Kezhong Ma, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China, and colleagues aimed to evaluate the potential predictive value of TBIL for long-term prognosis in patients with new-onset NSTEMI.
The study included patients with new-onset NSTEMI that underwent emergency coronary angiography between June 2015 to March 2020. At admission, baseline TBIL were measured. The severity of coronary lesions were indicated by SYNTAX scores.
Multivariate logistic regression was used to analyze the association between TBIL and SYNTAX. The patients were followed for the incidence of major adverse cardiac and cerebrovascular events (MACCEs). Kaplan–Meier survival methods were used to analyze the association between TBIL and MACCEs. A total of 327 patients were included in the study.
Following were the key findings of the study:
Patients were divided according to tertiles of TBIL (first tertile < 10.23 µmol/L, n = 109; second tertile 10.23–14.30 µmol/L, n = 109; and third tertile ≥ 14.30 µmol/L, n = 109).
TBIL was independently associated with the severity of coronary lesions in patients with NSTEMI, with an adjusted odd ratio (OR) for the third tertile and the second tertile compared with the first tertile of TBIL of 2.259 and 2.167, respectively.
After a mean follow-up of 30.33 months, MACCE had occurred in 57 patients.
TBIL was independently associated with the increased risk of MACCEs, with an adjusted hazard ratio (HR) for the third tertile and the second tertile compared with the first tertile of TBIL of 2.737 and 3.272, respectively.
"The results of this study suggest that myocardial infarction admission TBIL might be an inexpensive predictor of poor prognosis in patients with new-onset NSTEMI," the authors wrote.
Reference:
Yang, Y., Wang, J., Wai Si Ding, A.J.G.L. et al. Serum total bilirubin and long-term prognosis of patients with new-onset non-ST elevation myocardial infarction: a cohort study. BMC Cardiovasc Disord 22, 165 (2022). https://doi.org/10.1186/s12872-022-02607-8