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Background <p>In-stent restenosis (ISR) remains a major clinical challenge despite advances in stent technology and pharmacotherapy. While inflammation plays a pivotal role in ISR progression, the prognostic value of stable biomarkers reflecting chronic inflammation has not been fully explored. This study examined the association of serum total bilirubin (TBIL), alone and in combination with high-sensitivity C-reactive protein (hsCRP), with long-term cardiovascular outcomes in ISR patients undergoing percutaneous coronary intervention (PCI).</p> Methods <p>A total of 2055 ISR patients who underwent repeat PCI at Fuwai Hospital from January 2017 to December 2018 were consecutively enrolled. Patients were stratified based on TBIL and hsCRP levels. The primary endpoint was the incidence of major adverse cardiovascular events (MACEs), including all-cause mortality, myocardial infarction, stroke, repeat revascularization and stent thrombosis. Multivariable Cox regression and subgroup analyses were conducted.</p> Results <p>During a median follow-up of 36 months, 457 patients suffered from MACEs. Lower TBIL levels were independently associated with a higher risk of long-term MACEs, regardless of high hsCRP (hsCRP ≥ 2&#xa0;mg/L, hazard ratio [HR] = 1.865, 95% confidence interval [CI] 1.423–2.443, <i>P</i> &lt; 0.001) or low hsCRP (hsCRP &lt; 2&#xa0;mg/L HR = 1.338, 95% CI: 1.039–1.721, <i>P</i> = 0.024). Kaplan-Meier curves showed that patients with both low TBIL and elevated hsCRP had the highest incidence of MACEs (<i>P</i> &lt; 0.001). The combination of TBIL and hsCRP provided additional risk stratification information, especially in patients with diabetes mellitus (P for interaction = 0.001).</p> Conclusion <p>Serum TBIL is a novel, independent predictor of adverse outcomes in ISR patients and provides complementary value to hsCRP for risk stratification. Its clinical utility may be particularly valuable in diabetic populations, suggesting that TBIL may help identify higher-risk subgroups within ISR populations.</p> Clinical trial registration <p>This study is not a registered clinical trial. Clinical trial registration: not applicable.</p>

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Association of serum total bilirubin with recurrent cardiovascular events in patients with in-stent restenosis: a stratified analysis by inflammatory status

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月9日

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  • Miao Yu,
  • Yu Jiang,
  • Yu Sun,
  • Han Zhang,
  • Tian-Jie Wang,
  • Tao Tian,
  • Jian-Song Yuan,
  • Hai-Yan Qian,
  • Wei-Xian Yang

摘要

Background

In-stent restenosis (ISR) remains a major clinical challenge despite advances in stent technology and pharmacotherapy. While inflammation plays a pivotal role in ISR progression, the prognostic value of stable biomarkers reflecting chronic inflammation has not been fully explored. This study examined the association of serum total bilirubin (TBIL), alone and in combination with high-sensitivity C-reactive protein (hsCRP), with long-term cardiovascular outcomes in ISR patients undergoing percutaneous coronary intervention (PCI).

Methods

A total of 2055 ISR patients who underwent repeat PCI at Fuwai Hospital from January 2017 to December 2018 were consecutively enrolled. Patients were stratified based on TBIL and hsCRP levels. The primary endpoint was the incidence of major adverse cardiovascular events (MACEs), including all-cause mortality, myocardial infarction, stroke, repeat revascularization and stent thrombosis. Multivariable Cox regression and subgroup analyses were conducted.

Results

During a median follow-up of 36 months, 457 patients suffered from MACEs. Lower TBIL levels were independently associated with a higher risk of long-term MACEs, regardless of high hsCRP (hsCRP ≥ 2 mg/L, hazard ratio [HR] = 1.865, 95% confidence interval [CI] 1.423–2.443, P < 0.001) or low hsCRP (hsCRP < 2 mg/L HR = 1.338, 95% CI: 1.039–1.721, P = 0.024). Kaplan-Meier curves showed that patients with both low TBIL and elevated hsCRP had the highest incidence of MACEs (P < 0.001). The combination of TBIL and hsCRP provided additional risk stratification information, especially in patients with diabetes mellitus (P for interaction = 0.001).

Conclusion

Serum TBIL is a novel, independent predictor of adverse outcomes in ISR patients and provides complementary value to hsCRP for risk stratification. Its clinical utility may be particularly valuable in diabetic populations, suggesting that TBIL may help identify higher-risk subgroups within ISR populations.

Clinical trial registration

This study is not a registered clinical trial. Clinical trial registration: not applicable.