Correlation Between Serum Bilirubin Level And GRACE Score And Prognosis In Patients With Acute Myocardial Infarction

Background: At present,evidence-based medicien confirmed that percutaneous coronary intervention(PCI)treatment cansignificantly benefit patientswith acute myocardial infarction(AMI),reduce mortality,improve quality oflife and prolong life expectancy.The Global Registry of Acute Coronary Events Registry(GRACE)score is often clinically used to guide risk stratification and prognosis assessment in patients with acute coronary syndrome(ACS)because of its high accuracy and its ability to respond well to real-world conditions.In recent years,it has been found that serum bilirubin is negatively correlation with the incidence of coronary heart disease,and it has been proved that bilirubin is a new risk factor for cardiovascular disease.However,the relationship between bilirubin and the prognosis of patients with AMI treated by PCIis not clear.The aim of this study was to analyze the association of serum bilirubin levels with the GRACE score and recent prognosis in patients with AMI.Objective: To investigate the correlation between serum bilirubin level and GRACE score and the short-term prognosis in patients with AMI bydetecting the serum bilirubin concentration,calculating the GRACE score and observing the occurrence of major adverse cardiovascular events(MACE)in patients with AMI treated by PCI.Method:(1)From January2013 to February 2017,668 patients with AMI for the first time who stayed and accepted emergency PCI were chosen from the Department of Cardiology in the First Affiliated Hospital of Soochow University.All patients’ GRACE scores were calculated.(2)The clinical data of the patients were collected: age,sex,smoking history,history of hypertension,history of diabetes,hyperlipidemia,electrocardiogram,myocardial enzymes,troponin,Killip grading,GRACE score;coronary angiography and PCI;The next morning,fasting blood venous blood routine and biochemical results;MACE occurred during hospitalization,such as new onset of atrial fibrillation,ventricular tachycardia,ventricular fibrillation,III degree atrioventricular block,sinus slow,severe heart failure(Killip II-IV)or died.(3)According to the total bilirubin level,the patients were divided into four subgroups(G1:<25% G2:26-50% G3:51-75% G4: >75%).The correlation between bilirubin and GRACE score and MACE was analyzed.Result:(1)According to bilirubin level,patients were divided into four groups.Analysis of clinical data showed that smoking,hypertension,hyperlipidemia,PLT,HS-CRP,LDL,GRACE score,new-onsetatrial fibrillation and heart failure were statistically significant(P <0.05).Other factors such as age,sex,history of diabetes,heart rate,blood pressure,Cr,UA,TC,TG,angiogenic ratio,conduction block,ventricular tachycardia,ventricular fibrillation,hospital mortality and so on were not statistically significant(P> 0.05).Patients with low-level bilirubin had higher GRACE scores than those with high-level patients,and had a higher incidence of new-onset atrial fibrillation and heart failure during hospitalization.(2)Serum bilirubin was significantly lower in patients with high risk of GRACE than those in moderate risk and low risk(P <0.05).Pearson correlation analysis showed a negative correlation between total bilirubin and GRACE score(r =-0.188,P = 0.02).(3)Univariate analysis showed that age,sex,smoking history,history of diabetes,history of hypertension,heart rate,systolic blood pressure,diastolic blood pressure,WBC,NE,T-BIL,D-BIL,Cr,UA,GRACE score and the ratio of angiogenesis were significantly different between incident and non-incident groups(P <0.05).(4)Binary logistic regression analysis showed that smoking(OR = 1.131),WBC(OR = 1.036),UA(OR = 1.003),HS-CRP(OR = 1.059)and GRACE score(OR = 1.028)were independent risk factors for MACE during hospitalization in patients with AMI treated by PCI.Serum bilirubin levels(T-BIL,OR=0.783;D-BIL,OR= 0.702;I-BIL,OR=0.819)were the protective factors forthe prognosis of patients with AMI.Conclusion:(1)There is a negative correlation between serum bilirubin levels and GRACE scores in patients with AMI.(2)Serum bilirubin levels were associated with the incidence of new-onset atrial fibrillation and heart failure in patients with AMI treated by PCI.(3)Smoking,WBC,UA,HS-CRP,low bilirubin levels were independent risk factors for MACE in patients with AMI reated by PCI.