E-ISSN: 1305-9327 ISSN: 1305-9319
Evaluation of the Relationship Between Serum Bilirubin with hscTnT Levels and SYNTAX Score in Non-ST Elevation Acute Coronary Syndrome
PDF
Cite
Share
Request
Research
VOLUME: 15 ISSUE: 4
P: 362-367
December 2019

Evaluation of the Relationship Between Serum Bilirubin with hscTnT Levels and SYNTAX Score in Non-ST Elevation Acute Coronary Syndrome

Med J Bakirkoy 2019;15(4):362-367
DOI: 10.4274/BTDMJB.galenos.2019.20181031045809
Emrah Ermiş
Hakan Uçar
1. Biruni Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, İstanbul, Türkiye
No information available.
No information available
Received Date: 31.10.2018
Accepted Date: 17.02.2019
Publish Date: 20.12.2019
PDF
Cite
Share
Request

ABSTRACT

Objective:

We investigated the relationship between high-sensitivity cardiac troponin T (hs-cTnT), which has been recently introduced in many emergency departments because of its very high negative predictive value in the diagnosis and differential diagnosis of non-ST elevated myocardial infarction (NSTEMI), and serum bilirubin levels.

Methods:

A total of 371 patients who admitted to the emergency department with the complaint of chest pain and hs-cTnT (+), were hospitalized with the diagnosis of NSTEMI and who underwent coronary angiography, and 374 patients with hs-cTnT (-) as the control group were included in the study. Serum bilirubin levels (total and direct) were studied and compared between the two groups. In addition, the median SYNTAX (SX) score was determined in hs-cTnT (+) patient group and a sub-analysis was performed. Accordingly, bilirubin levels were investigated between the group with low SX scores (<12) and the group with high SX scores.

Results:

When bilirubin levels were compared; no significant difference was found between hs-cTnT (+) and hs-cTnT (-) groups in terms of both total and direct bilirubin values, with total bilirubin being at the limit (total bilirubin, p=0.05; direct bilirubin, p=0.42; respectively). In the correlation analysis, a moderate positive correlation was found only between hs-cTnT and total bilirubin (r=0.43, p=0.042). When the correlation of total and direct bilirubin with SX score was examined; both total and direct bilirubin values were decreased as the SX score was increased, but this negative correlation was not statistically significant.

Conclusion:

The results of this study show that serum bilirubin, which has been shown in numerous studies to be significantly associated with cardiac troponins (I and T), even an independent predictor of high troponin levels in NSTEMI, has a low sensitivity against cardiomyocyte damage in very early period. In our study, we could not find a correlation between bilirubin values and hs-cTnT. However, considering the severity of coronary artery disease, high bilirubin levels were found in patients with a low SX score (median SX score=12 in this study) in the regression analysis, supporting a negative correlation independently from myocardial infarction and hs-cTnT levels as reported in previous studies.

Keywords:
Bilirubin, high-sensitivity cardiac troponin T, non-ST elevated myocardial infarction

References

1
Masri W, Le Guillou E, Hamdi E, Ghazal K, Lebigot E, Cosson C, et al. Troponin elevation in other conditions than acute coronary syndromes. Ann Biol Clin (Paris). 2017;75:411-9.
2
Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37:267-315.
3
Chapman AR, Hesse K, Andrews J, Ken Lee K, Anand A, Shah ASV, et al. High-Sensitivity Cardiac Troponin I and Clinical Risk Scores in Patients With Suspected Acute Coronary Syndrome. Circulation 2018;138:1654-65.
4
Amanvermez R, Acar E, Gunay M, Baydın A, Yardan T, Bek Y. Hsp 70, hsCRP and oxidative stress in patients with acute coronary syndromes. Bosn J Basic Med Sci 2012;12:102-7.
5
Serdar Z, Serdar A, Altin A, Eryilmaz U, Albayrak S. The relation between oxidant and antioxidant parameters and severity of acute coronary syndromes. Acta Cardiol. 2007;62:373-80.
6
Schwertner HA, Jackson WG, Tolan G. Association of low serum concentration of bilirubin with increased risk of coronary artery disease. Clin Chem 1994;40:18-23.
7
Breimer LH, Wannamethee G, Ebrahim S, Shaper AG. Serum bilirubin and risk of ischemic heart disease in middle-aged British men. Clin Chem 1995;41:1504.
8
Turfan M, Duran M, Poyraz F, Yayla C, Akboga MK, Sahinarslan A, et al. Inverse relationship between serum total bilirubin levels and severity of disease in patients with stable coronary artery disease. Coron Artery Dis 2013;24: 29-32.
9
Gul M, Uyarel H, Ergelen M, Akgul O, Karaca G, Turen S, et al. Prognostic value of total bilirubin in patients with ST-segment elevation acute myocardial infarction undergoing primary coronary intervention. Am J Cardiol 2013;111:166-71.
10
Kaya MG, Sahin O, Akpek M, Duran M, Uysal OK, Karadavut S, et al. Relation between serum total bilirubin levels and severity of coronary artery disease in patients with non-ST-segment elevation myocardial infarction. Angiology 2014;65:245-9.
11
Ozturk M, Askın L, Ipek E, Demirelli S, Turan OE, Yıldırım E, et al. The Role of Serum Bilirubin Levels in Predicting Troponin Positivity in Non-ST-Segment Elevation Acute Coronary Syndrome. Angiology 2017;68:414-18.
12
Chang CC, Hsu CY, Huang PH, Chiang CH, Huang SS, Leu HB, et al. Association of Serum Bilirubin with SYNTAX Score and Future Cardiovascular Events in Patients Undergoing Coronary Intervention. Acta Cardiol Sin 2016;32:412-9.
13
Novotný L, Vítek L. Inverse relationship between serum bilirubin and atherosclerosis in men: a meta-analysis of published studies. Exp Biol Med (Maywood) 2003; 228: 568-71.
14
Wu TW, Fung KP, Wu J, Yang CC, Weisel RD. Antioxidation of human low density lipoprotein by unconjugated and conjugated bilirubins. Biochem Pharmacol 1996;51: 859-62.
15
Leopold JA, Loscalzo J. Oxidative enzymopathies and vascular disease. Arterioscler Thromb Vasc Biol 2005;25:1332-40.
16
Stocker R, Keaney JF Jr. Role of oxidative modifications in atherosclerosis. Physiol Rev 2004;84:1381-478.
17
Pae HO, Son Y, Kim NH, Jeong HJ, Chang KC, Chung HT. Role of heme oxygenase in preserving vascular bioactive NO. Nitric Oxide 2010; 23:251-7.
18
Kundur AR, Singh I, Bulmer AC. Bilirubin, platelet activation and heart disease: a missing link to cardiovascular protection in Gilbert’s syndrome? Atherosclerosis 2015; 239:73-84.
19
Erdogan T, Ciçek Y, Kocaman SA, Canga A, Cetin M, Durakoglugil E,et al.Increased serum bilirubin level is related to good collateral development in patients with chronic total coronary occlusion. Intern Med 2012;51:249-55.
20
Canpolat U, Aytemir K, Yorgun H, Hazırolan T, Kaya EB, Şahiner L,. Association of serum total bilirubin levels with the severity, extent and subtypes of coronary atherosclerotic plaques detected by coronary CT angiography. Int J Cardiovasc Imaging 2013; 29:1371-9.
21
Lakkisto P, Palojoki E, Backlund T, Saraste A, Tikkanen I, Voipio-Pulkki LM, et al. Expression of heme oxygenase-1 in response to myocardial infarction in rats. J Mol Cell Cardiol 2002;34:1357-65.
22
Okuhara K, Kisaka T, Ozono R, Kurisu S, Inoue I, Soga J. Change in bilirubin level following acute myocardial infarction is an index for heme oxygenase activation. South Med J 2010;103:876-81.