Dataset Information

Predicting value of white cell count and total bilirubin on clinical outcomes in patients with ST-elevation myocardial infarction following percutaneous coronary intervention: a cohort study.

ABSTRACT:

Objectives

A combined equation based on white cell count (WCC) and total bilirubin (TB) was assessed for its ability to predict adverse clinical outcomes in patients with acute ST-segment elevation myocardial infarction (STEMI) with primary percutaneous coronary intervention (PCI).

Design

A single-centre, prospective cohort study.

Setting

The First Affiliated Hospital of Xinjiang Medical University.

Method

A total of 615 patients with STEMI postprimary PCI were enrolled. WCC and TB were collected at admission. Logistic regression was used to determine the combined equation. The primary endpoints were in-hospital mortality and major adverse cardiovascular events (MACE), which composed of cardiac death, cardiac shock, malignant arrhythmia (ventricular tachycardia, ventricular fibrillation), severe cardiac insufficiency, non-fatal myocardial infarction, angina pectoris readmission, severe cardiac insufficiency (cardiac III-IV level), stent restenosis and target vessels revascularisation during the hospitalisation and 36 months follow-up period.

Result

77 patients occurred in MACE during the hospitalisation (17 in-hospital mortality). WCC and TB were taken as an independent variables to make a category of logistic regression analysis of in-hospital MACE, the logistic regression model was: logit (P)=-8.00+0.265 WCC+0.077 TB, the combination of WCC and TB was more valuable on evaluating the in-hospital mortality (area under the curve 0.804, 95% CI 0.678 to 0.929, p<0.001). Multivariate logistic regression analysis showed that combined detection was an independent risk factor for in-hospital MACE (OR 5.85, 95% CI 3.425 to 9.990, p=0.032). During the follow-up period, 172 patients (29.5%) developed MACE. But the combined detection did not predict the long-term clinical outcome.

Conclusion

The combination of WCC and TB is an independent predictor for in-hospital outcomes in patients with STEMI than single detection.

SUBMITTER: Tuxun M

PROVIDER: S-EPMC7044918 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Publications

Predicting value of white cell count and total bilirubin on clinical outcomes in patients with ST-elevation myocardial infarction following percutaneous coronary intervention: a cohort study.

Tuxun Munire M Zhao Qian Q Xiang Yang Y Liu Fen F Shan Chun-Fang CF Zhou Xin-Rong XR Song Ning N Waisiding Ajiguli A Zhang Xue-He XH Aihemaiti Gulandanmu G Yang Yi-Ning YN Li Xiao-Mei XM

BMJ open 20200218 2

<h4>Objectives</h4>A combined equation based on white cell count (WCC) and total bilirubin (TB) was assessed for its ability to predict adverse clinical outcomes in patients with acute ST-segment elevation myocardial infarction (STEMI) with primary percutaneous coronary intervention (PCI).<h4>Design</h4>A single-centre, prospective cohort study.<h4>Setting</h4>The First Affiliated Hospital of Xinjiang Medical University.<h4>Method</h4>A total of 615 patients with STEMI postprimary PCI were enrol ...[more]

PMID: 32075822

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Project description:ObjectivesGlobal left ventricular (LV) function is routinely used to assess cardiac function; however, myocardial strain is able to identify more subtle dysfunction. We aimed to determine the recovery and prognostic value of featuring tracking (FT) cardiovascular magnetic resonance (CMR) strain in ST-segment elevation myocardial infarction (STEMI) patients with a concurrent chronic total occlusion (CTO).MethodsIn the randomized EXPLORE trial, there was no significant difference in global LV function after percutaneous coronary intervention (PCI) of the CTO, compared with no-CTO PCI, post-STEMI. In the current study, we included 200 of the 302 EXPLORE patients with a baseline CMR, of which 180 also had 4-month follow-up (serial) CMR. Global longitudinal strain (GLS) was calculated from 3 long-axis views. Global circumferential strain (GCS) and segmental strain were calculated from 3 short-axis views (basal, mid, and apical).ResultsGlobal strain significantly improved at 4 months (GLS ∆ - 1.8 ± 4.3%, p < 0.001; GCS ∆ - 1.7 ± 4.7%, p < 0.001); however, there was no treatment effect of CTO-PCI on strain recovery. GLS was a significant predictor for 4 months of LV ejection fraction (p = 0.006), incremental to other CMR parameters including infarct size. For mortality, infarct size remained the strongest predictor. On regional level, segmental strain independently predicted recovery in the dysfunctional segments (p < 0.001).ConclusionsGlobal and segmental myocardial strains significantly improved over time, with no effect of CTO-PCI. Global strain was associated with outcome and segmental strain was an independent predictor for regional LV recovery in the dysfunctional CTO territory. Further research is needed to determine the additional prognostic value of strain beyond routine CMR parameters.Key points• In STEMI patients with a concurrent CTO, strain significantly improves over time, regardless of CTO-PCI. • Global strain is an independent predictor for functional recovery, incremental to infarct size, LVEF, and clinical parameters. • Segmental strain was able to predict the recovery of wall thickening, incremental to transmural extent of infarction.

Project description:PurposeTo investigate the association between serum bilirubin levels and in-hospital Major Adverse Cardiac Events (MACE) in patients with ST-segment Elevation Myocardial Infarction (STEMI) undergoing primary Percutaneous Coronary Intervention (PCI).MethodsA total of 418 patients with STEMI who underwent primary PCI were enrolled from October 1st, 2021 to October 31st 2022. The average age of enrolled participants was 59.23 years, and 328 patients (78.50%) were male patients. Patients were divided into MACE (patients with angina pectoris after infarction, recurrent myocardial infarction, acute heart failure, cardiogenic shock, malignant arrhythmias, or death after primary PCI) (n = 98) and non-MACE (n = 320) groups. Univariate and multivariate logistic regression analyses were performed to estimate the association between different bilirubin levels including Total Bilirubin (TB), Direct Bilirubin (DB), Indirect Bilirubin (IDB), and risk of in-hospital MACE. The area under the Receiver Operating Characteristic (ROC) curve was used to determine the accuracy of bilirubin levels in predicting in-hospital MACE.ResultsThe incidence of MACE in STEMI patients increased from the lowest to the highest bilirubin tertiles. Multivariate logistic regression analysis showed that increased total bilirubin level was an independent predictor of in-hospital MACE in patients with STEMI (p for trend = 0.02). Compared to the first TB group, the ORs for risk of MACE were 1.58 (95% CI 0.77‒3.26) and 2.28 (95% CI 1.13‒4.59) in the second and third TB groups, respectively. The ROC curve analysis showed that the areas under the curve for TB, DB and IDB in predicting in-hospital MACE were 0.642 (95% CI 0.578‒0.705, p < 0.001), 0.676 (95% CI 0.614‒0.738, p < 0.001), and 0.619 (95% CI 0.554‒0.683, p < 0.001), respectively.ConclusionsThe current study showed that elevated TB, DB, and IDB levels are independent predictors of in-hospital MACE in patients with STEMI after primary PCI, and that DB has a better predictive value than TB and IDB.

Dataset Information

Predicting value of white cell count and total bilirubin on clinical outcomes in patients with ST-elevation myocardial infarction following percutaneous coronary intervention: a cohort study.

Objectives

Design

Setting

Method

Result

Conclusion

Publications

Predicting value of white cell count and total bilirubin on clinical outcomes in patients with ST-elevation myocardial infarction following percutaneous coronary intervention: a cohort study.

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