Background Many diseases with elevated total bile acids (TBA) concentrations have varying degrees of abnormal cardiac electrophysiological activity, such as prolonged corrected QT (QTc) interval. In non-ST elevation myocardial infarction (NSTEMI) patients, prolonged QTc interval indicate poor prognosis. Therefore, we surveyed the relationship between TBA and QTc prolongation in NSTEMI patients.

Methods This retrospective analysis examined 328 individuals from Chinese population from January 2019 to January 2022. We used the median serum TBA concentration to divide the study population into two groups (Low-TBA: < 2.8 µmol/L; High-TBA ≥ 2.8 µmol/L). Logistic regression models were constructed to investigate the associations of serum TBA with QTc prolongation. Spearman correlation analyses were conducted to determine variables linked to TBA.

Results The prevalence of QTc prolongation immediately upon admission in the NSTEMI patients was 11.89%, 16.27% in the Low-TBA group, 7.41% in High-TBA group. Low-TBA was an independent risk factor associated with QTc prolongation (OR 2.493, 95% CI 1.090-5.700, P = 0.030). Spearman correlation analyses showed linear negative correlations of TC, LDL-C and ApoB with TBA. The same tendency of leukocytes, neutrophils and neutrophil-to-lymphocyte ratio being inversely proportional to TBA was found.

Conclusion Lower TBA was an independent risk factor associated with QTc prolongation. And TBA may affect cardiac electrical activity by affecting lipid metabolism and inflammation.