Increased Serum Bilirubin Level is Related to Good Collateral Development in Patients with Chronic Total Coronary Occlusion

Abstract

Objective Bilirubin is a bile pigment with potent anti-oxidant properties; in previous studies it has been reported to be negatively associated with coronary artery disease (CAD). Although elevated serum bilirubin concentrations may protect against endothelial dysfunction, it is not clear whether higher serum bilirubin levels (SBLs) in physiological ranges may work in favor of good collateral development in patients with chronic total coronary occlusion (CTO). Methods The study population consisted of patients who underwent coronary angiography with a suspicion of CAD. Patients who had CTO in at least one major coronary artery were included. Coronary angiograms of 179 eligible patients from our database were reanalyzed and 110 of them had good collateral development and 69 had poor collateral development according to the Cohen-Rentrop method. Results Patients with good collateral development had a lower fasting plasma glucose level (FPG) (p= 0.024) and higher SBLs in comparison to patients with poor collateral development (p<0.001). The number of CTO vessels (p=0.013) and left ventricular ejection fraction (EF%) were higher in good collateral group than poor collateral group (p=0.017). In multivariate analysis, FPG negatively (odds ratio [OR]: 0.981, p= 0.003) and SBL (OR for per 0.1-mg/dL increase: 1.832, p<0.001) and the number of CTO vessels (OR: 5.642, p=0.007) were positively related to coronary collateral development. Conclusion This study suggests that higher bilirubin levels within relatively normal ranges were related with favorable coronary collateral growth in patients with CTO. SBL may be responsible for the difference in coronary collateral vessel development among different patients with coronary artery disease. The antiinflammatory and anti-oxidant properties of bilirubin may mediate this effect.

A novel predictor of infarct-related artery patency before percutaneous intervention and in-hospital outcomes for ST-segment elevation myocardial infarction patients: serum bilirubin level

“…Erdogan et al . [20] evaluated undergoing coronary angiography for CAD and found that greater bilirubin levels were related to favorable coronary collateral flow in patients with chronic total occlusion. Okuhara et al .…”

Circulating bilirubin and defense against kidney disease and cardiovascular mortality: mechanisms contributing to protection in clinical investigations

“…Erdogan et al (41) first investigated the possible effects of serum bilirubin on coronary collateral development in patients with CAD who experienced total coronary occlusion. This study indicated that serum total bilirubin concentrations were positively related to collateral development.…”

“…This study indicated that serum total bilirubin concentrations were positively related to collateral development. NO plays a crucial role in the development of collateral vessels, and therefore bilirubin may be an important mediator increasing NO bioavailability, augmenting collateral development (41) and reducing amputation rates in type II diabetic patients (23). NO is considered the most important endothelium-derived relaxing substance (54), with endothelial dysfunction often characterized by a loss of NO bioavailability.…”

Association of serum total bilirubin levels with diastolic dysfunction in heart failure with preserved ejection fraction

“…Earlier researches have demonstrated an inverse correlation between serum bilirubin and the risk of coronary artery disease and decreased antioxidant activity of bilirubin in atherosclerotic lesions [1, 2]. Recent studies have confirmed the correlation between serum bilirubin levels and collateral development in patients with chronic total coronary occlusion [3], peripheral arterial disease [4], amputation events in type-2 diabetes mellitus [5], stroke severity and clinical outcomes [6]. Those results suggested that bilirubin may be a part of a cell defense strategy in those macro- and micro- angiopathies.…”