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Meta-Analysis
. 2019 Jan;98(3):e13920.
doi: 10.1097/MD.0000000000013920.

Prognostic value of total bilirubin in patients with acute myocardial infarction: A meta-analysis

Hongyou Shen  1 , Canhui Zeng, Xiaowei Wu, Shizhao Liu, Xiaomin Chen
Affiliations
Meta-Analysis

Prognostic value of total bilirubin in patients with acute myocardial infarction: A meta-analysis

Hongyou Shen et al. Medicine (Baltimore). 2019 Jan.

Abstract

Background: Experimental data obtained in animal models supported the protective role of bilirubin. However, clinical studies regarding the prognostic role of total bilirubin in patients with acute myocardial infarction (AMI) are conflicting. We, therefore, undertook this meta-analysis to evaluate the prognostic value of serum total bilirubin in AMI patients.

Methods: Relevant studies were searched from PubMed and EMBASE databases up to April 15, 2018. Studies evaluating the outcomes in relation to serum total bilirubin in AMI patients and reporting multivariable-adjusted risk estimate of the prognostic value were eligible. The outcome measures were major adverse cardiac events (MACEs), cardiovascular death, and all-cause mortality.

Results: Six studies involving 14,554 AMI patients were identified. Meta-analysis indicated that higher total bilirubin was associated with an increased risk of MACEs (risk ratio [RR] 1.65; 95% confidence intervals [CI] 1.25-2.19) and cardiovascular death (RR 2.12; 95%CI 1.24-3.64). However, higher serum total bilirubin did not significantly increase all-cause mortality risk (RR 1.31; 95%CI 0.75-2.28). Subgroup analyses by the types of AMI and study design supported the pooled results.

Conclusions: Higher serum total bilirubin level is a predictor of MACEs and cardiovascular death in patients with AMI. However, interpretation of these findings should be with caution due to the impact of cardiac dysfunction after AMI.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1
Flow chart showing the study selection process.
Figure 2
Figure 2
Forest plots showing risk ratio and 95% confidence interval of major adverse cardiac events for the higher versus lower serum total bilirubin level.
Figure 3
Figure 3
Forest plots showing risk ratio and 95% confidence interval of cardiovascular mortality for the higher versus lower serum total bilirubin level.
Figure 4
Figure 4
Forest plots showing risk ratio and 95% confidence interval of all-cause of mortality for the higher versus lower serum total bilirubin level.
See this image and copyright information in PMC

References

    1. Reed GW, Rossi JE, Cannon CP. Acute myocardial infarction. Lancet 2017;389:197–210. - PubMed
    1. Rentrop KP, Feit F. Reperfusion therapy for acute myocardial infarction: concepts and controversies from inception to acceptance. Am Heart J 2015;170:971–80. - PubMed
    1. Johansson S, Rosengren A, Young K, et al. Mortality and morbidity trends after the first year in survivors of acute myocardial infarction: a systematic review. BMC Cardiovasc Disord 2017;17:53. - PMC - PubMed
    1. Wei S, Mao L, Liu B, et al. Serum biomarkers and the prognosis of AMI patients. Herz 2014;39:384–9. - PubMed
    1. Gazzin S, Vitek L, Watchko J, et al. A novel perspective on the biology of bilirubin in health and disease. Trends Mol Med 2016;22:758–68. - PubMed