Xu C, et al. - In this study that included 533 consecutive patients, researchers investigated the association of subtypes of total bilirubin (direct bilirubin and indirect bilirubin) with long-term outcomes in patients with acute coronary syndrome (ACS). The composite end point was cardiac death, revascularization and acute heart failure, which was assessed during follow-up. Significant association of higher serum direct bilirubin (DB) levels with major adverse cardiac events (MACE) was shown by Kaplan–Meier curve at a median follow-up of 2.4 years; however, no association of total bilirubin (TB) and indirect bilirubin (IDB) with MACE was evident. In ACS, increased risk of MACE was observed in association with high TB and DB in Cox analysis; this was found even after adjustment of cardiovascular risk factors. Predictive value of DB for MACE was also demonstrated by the receiver operating characteristic (ROC) curve. Overall, an increased risk of MACE was observed in relation to high TB and DB but not IDB in ACS, and DB had a superior prognostic value than TB or IDB.