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Association of serum bilirubin with contrast-induced nephropathy and future cardiovascular events in patients undergoing coronary intervention.

Huang SS, Huang PH, Wu TC, Chen JW, Lin SJ - PLoS ONE (2012)

Bottom Line: CIN is a serious complication of coronary intervention.Higher serum bilirubin concentrations were associated with lower risk of CIN and fewer cardiovascular events.The development of interventions that promote bilirubin levels may be a potential target to reduce CIN and future MACE in patients undergoing coronary intervention.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.

ABSTRACT

Objectives: Enhanced reactive oxygen species formation within the kidney following the administration of contrast media may play a key role in the development of contrast-induced nephropathy (CIN). Bilirubin has emerged as an important endogenous antioxidant molecule. This study was undertaken to determine whether bilirubin is associated with CIN and future cardiovascular events in patients undergoing coronary intervention.

Methods: Totally, 544 consecutive patients received coronary intervention were enrolled. All patients were followed up for at least 3 years or until the occurrence of a major event. The primary endpoint was CIN, defined as a rise in serum creatinine (SCr) of 0.5 mg/dl or a 25% increase from the baseline value within 48 hours after the procedure. The secondary endpoint was the combined occurrence of major adverse cardiovascular events (MACE), including death, nonfatal myocardial infarction, and ischemic stroke.

Results: Overall, CIN occurred in 85 (15.6%) patients. All patients were stratified into 3 groups (low/normal/high) according to the serum bilirubin levels. In a multivariate logistic analysis, the odds ratio for CIN with low-bilirubin levels relative to high-bilirubin levels was 11.82 (95% CI, 3.25-43.03). By Cox regression analysis, serum bilirubin levels was an independent predictor of MACE in patients undergoing coronary intervention (low vs. high hazard ratio 2.26; 95% CI, 1.05-4.90).

Conclusions: CIN is a serious complication of coronary intervention. Higher serum bilirubin concentrations were associated with lower risk of CIN and fewer cardiovascular events. The development of interventions that promote bilirubin levels may be a potential target to reduce CIN and future MACE in patients undergoing coronary intervention.

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Kaplan–Meier survival curves stratified by the serum bilirubin levels.The MACE-free survival rate was significantly reduced in patients with lower serum bilirubin levels (P = 0.001 by log-rank test).
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pone-0042594-g002: Kaplan–Meier survival curves stratified by the serum bilirubin levels.The MACE-free survival rate was significantly reduced in patients with lower serum bilirubin levels (P = 0.001 by log-rank test).

Mentions: In order to determine the relationship between survival free of adverse events and serum bilirubin levels, Kaplan–Meier survival analysis was performed. Patients with lower serum bilirubin concentrations had significantly reduced MACE-free survival rate (P = 0.001), as illustrated in Figure 2.


Association of serum bilirubin with contrast-induced nephropathy and future cardiovascular events in patients undergoing coronary intervention.

Huang SS, Huang PH, Wu TC, Chen JW, Lin SJ - PLoS ONE (2012)

Kaplan–Meier survival curves stratified by the serum bilirubin levels.The MACE-free survival rate was significantly reduced in patients with lower serum bilirubin levels (P = 0.001 by log-rank test).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3412818&req=5

pone-0042594-g002: Kaplan–Meier survival curves stratified by the serum bilirubin levels.The MACE-free survival rate was significantly reduced in patients with lower serum bilirubin levels (P = 0.001 by log-rank test).
Mentions: In order to determine the relationship between survival free of adverse events and serum bilirubin levels, Kaplan–Meier survival analysis was performed. Patients with lower serum bilirubin concentrations had significantly reduced MACE-free survival rate (P = 0.001), as illustrated in Figure 2.

Bottom Line: CIN is a serious complication of coronary intervention.Higher serum bilirubin concentrations were associated with lower risk of CIN and fewer cardiovascular events.The development of interventions that promote bilirubin levels may be a potential target to reduce CIN and future MACE in patients undergoing coronary intervention.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.

ABSTRACT

Objectives: Enhanced reactive oxygen species formation within the kidney following the administration of contrast media may play a key role in the development of contrast-induced nephropathy (CIN). Bilirubin has emerged as an important endogenous antioxidant molecule. This study was undertaken to determine whether bilirubin is associated with CIN and future cardiovascular events in patients undergoing coronary intervention.

Methods: Totally, 544 consecutive patients received coronary intervention were enrolled. All patients were followed up for at least 3 years or until the occurrence of a major event. The primary endpoint was CIN, defined as a rise in serum creatinine (SCr) of 0.5 mg/dl or a 25% increase from the baseline value within 48 hours after the procedure. The secondary endpoint was the combined occurrence of major adverse cardiovascular events (MACE), including death, nonfatal myocardial infarction, and ischemic stroke.

Results: Overall, CIN occurred in 85 (15.6%) patients. All patients were stratified into 3 groups (low/normal/high) according to the serum bilirubin levels. In a multivariate logistic analysis, the odds ratio for CIN with low-bilirubin levels relative to high-bilirubin levels was 11.82 (95% CI, 3.25-43.03). By Cox regression analysis, serum bilirubin levels was an independent predictor of MACE in patients undergoing coronary intervention (low vs. high hazard ratio 2.26; 95% CI, 1.05-4.90).

Conclusions: CIN is a serious complication of coronary intervention. Higher serum bilirubin concentrations were associated with lower risk of CIN and fewer cardiovascular events. The development of interventions that promote bilirubin levels may be a potential target to reduce CIN and future MACE in patients undergoing coronary intervention.

Show MeSH
Related in: MedlinePlus