The Association between Serum Total Bile Acid Level and Long-Term Prognosis in Patients with Coronary Chronic Total Occlusion Undergoing Percutaneous Coronary Intervention

Abstract

Background and Aims. Bile acids, the key products for elimination of cholesterol, play an important role in coronary artery disease (CAD). However, few studies focused on the roles of more accessible serum total bile acids (TBA) in the prediction of adverse cardiovascular events for coronary chronic artery occlusion (CTO). The aim of this study was to explore the potential relationship between serum TBA and long-term prognosis in patients with CTO undergoing percutaneous coronary intervention (PCI). Methods. Baseline TBA was determined in 613 patients with CTO after PCI in the present study. All patients were divided into 3 groups according to the median (3.5 μmol/l) and the normal upper limit of the TBA (10 μmol/l). The primary endpoint was all-cause mortality, and the secondary endpoint was major adverse cardiovascular events (MACE). Results. Average age in this study was $65.44\pm 9.94$ years old. The median of TBA was 3.5 (2.1-6.1) μmol/l. Over a median follow-up of 33.5 months, compared to those with below 3.5 μmol/l TBA, 3.5 ~ 10 μmol/l TBA was associated with significantly reduced risk for the MACE (hazard ratio (HR): 0.59, 95% confidence interval (CI): 0.40 to 0.88; $p=0.009$ ) even after adjustment for baseline variables. However, TBA did not predict all-cause mortality and cardiovascular death. Spline analyses showed an L-shaped relationship of the serum TBA with the incidence of MACE. Conclusions. Moderate fasting serum TBA level has a predictive value for MACE even after adjusting for lifestyle and clinical risk factors in CTO patients undergoing PCI.