Thyroid stimulating hormone elevation as a predictor of long‐term mortality in patients with acute myocardial infarction

Seo, Suk Min; Koh, Yoon Seok; Park, Hun‐Jun; Kim, Dong‐Bin; Her, Sung Ho; Lee, Jong Min; Park, Chul Soo; Kim, Pum-Joon; Kim, Hee-Yeol; Yoo, Ki Dong; Jeon, Doo Soo; Ahn, Young Keun; Jeong, Myung Ho; Chung, Wook Sung; Seung, Ki‐Bae

doi:10.1002/clc.23062

Cited by 29 publications

(24 citation statements)

References 26 publications

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“… Seo et al. 13 2018 Retrospective AMI 1977 At admission 3.5 years TSH elevation was a predictor of all-cause mortality in patients with AMI. Thyroid function in patients with AMI is associated with prognosis.…”

Section: The Prognostic Value Of Thyroid Dysfunction In Acsmentioning

confidence: 98%

“… 12 It is well established that overt hyperthyroidism initiates hyperdynamic cardiovascular state 12 like increased systolic blood pressure, pulmonary hypertension, and atrioventricular valve regurgitation, 4 whereas overt hypothyroidism is correlated with diastolic hypertension, dyslipidemia, atherosclerotic plaque progression and instability, including endothelial dysfunction. 6 , 7 , 13 …”

Section: Clinical Impact Of Alterations In Thyroid Functionmentioning

confidence: 99%

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Prognostic implications of thyroid hormone alterations in acute coronary syndrome–A systematic review

Arambam

Kaul

Ranjan

et al. 2021

Indian Heart Journal

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There is considerable association of thyroid function and the cardiovascular system during various acute systemic illnesses. It is well established that the normal thyroid homeostasis is known to alter in disease states including the acute coronary syndromes (ACS). Abnormal thyroid hormonal status has been shown to be related to worse outcomes and prognosis. This review focuses on the relationship of alterations in thyroid function and its influence on the pathophysiological mechanisms and cardiovascular hemodynamics in ACS and based upon the literature, summarises all the existing evidence to this date on this subject. The data largely points out that low levels of triiodothyronine (T3) levels seen in ACS might be useful in prognosticating the outcomes of ACS.

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Section: The Prognostic Value Of Thyroid Dysfunction In Acsmentioning

confidence: 98%

Section: Clinical Impact Of Alterations In Thyroid Functionmentioning

confidence: 99%

Prognostic implications of thyroid hormone alterations in acute coronary syndrome–A systematic review

Arambam

Kaul

Ranjan

et al. 2021

Indian Heart Journal

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“…Altered thyroid function and increased NT-proBNP are prognostic factors in patients with AMI (7)(8)(9)(10)13). The present study aimed to investigate the values of fT3 and NT-proBNP as prognostic factors for long-term outcomes in patients with AMI undergoing PCI.…”

Section: Discussionmentioning

confidence: 96%

“…Thyroid hormones (THs) such as triiodothyronine (T3) play important roles in body metabolism and homeostasis, including cardiovascular homeostasis. Thyroid dysfunction is a strong predictor of mortality in patients with heart disease (7)(8)(9)(10). TH metabolism changes after AMI, resulting in low serum T3 levels despite normal thyroid-stimulating hormone (TSH) and thyroxine (T4) levels (11).…”

Section: Acute Myocardial Infarction (Ami) Is a Leading Cause O F M O R B I D I T Y A N D M O R T A L I T Y W O R L D W I D E ( 1 )mentioning

confidence: 99%

Prognostic value of free triiodothyronine and N-terminal pro-B-type natriuretic peptide for patients with acute myocardial infarction undergoing percutaneous coronary intervention: a prospective cohort study

Wang¹,

Wang²,

Zhang³

et al. 2021

Ann Transl Med

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Background: Altered thyroid function and increased N-terminal pro-B-type natriuretic peptide (NT-proBNP) are prognostic factors in acute myocardial infarction (AMI). The study aims to investigate whether free triiodothyronine (fT3) and NT-proBNP are prognostic factors for long-term outcomes in patients with AMI undergoing percutaneous coronary intervention (PCI).Methods: This was an observational, prospective, single-center study of consecutive patients enrolled at Fuwai Hospital between January, 2013 and December, 2013. The patients were divided into two groups according to fT3 levels: low fT3 (<2.5 pg/mL) and normal fT3 (2.50-4.09 pg/mL). The primary outcome of this study was the incidence of major adverse cardiovascular events (MACEs).Results: There were 252 patients with low fT3 and 561 patients with normal fT3. After >2 years of follow-up, patients with low fT3 levels had higher rates of MACEs than those with normal fT3 (27.0% vs. 7.8%, P<0.001). Univariable Cox proportional hazards regression analyses showed that NT-proBNP >802.7 pg/mL [hazard ratio (HR) =5.063, 95% confidence interval (CI): 3.176-8.071, P<0.001] and fT3 <2.5 pg/mL (HR =3.867, 95% CI: 2.646-5.651, P<0.001) were the strongest predictors of MACEs.After adjustment for traditional risk predictors, fT3 <2.5 pg/mL (HR =2.570, 95% CI: 1.653-3.993, P<0.001) was one of the most important independent predictors of MACEs. Patients with NT-proBNP ≤802.7 pg/mL and fT3 ≥2.5 pg/mL had the best prognosis, while patients with NT-proBNP >802.7 pg/mL and fT3 <2.5 pg/mL had the worst outcomes (P<0.001).Conclusions: Low fT3 is a strong predictor of poor prognosis after AMI. The fT3+NT-proBNP combination might be a valuable predictor of the long-term outcomes of PCI after AMI.

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“…A study of 4748 patients with AMI undergoing percutaneous coronary intervention found an increased risk for all cause and cardiac mortality for those found to have elevated TSH levels (including patients with a previous diagnosis of hypothyroidism) when compared to those who were euthyroid [28]. Furthermore, the restoration of euthyroidism in this acute setting has been associated with cardioprotective effects in animal models, including the reduction of the myocardial infarction area, induction of physiological hypertrophy, and positive cardiac remodeling [29][30][31][32].…”

Section: Discussionmentioning

confidence: 99%

Management of Hypothyroidism in Patients with Acute Myocardial Infarction

et al. 2020

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Background and Objectives: Thyroid hormones (TH) affect cardiac function through effects on cardiac contractility and systemic vascular resistance. While TH replacement for patients with hypothyroidism might be necessary for restoration of cardiac output after an acute myocardial infarction (AMI), it could theoretically lead to excessively rapid restoration of the metabolic rate. The appropriate management of hypothyroidism in patients with AMI is unknown. We describe the practice patterns in the management of hypothyroidism in the setting of AMI as well as patients’ clinical outcomes. Material and Methods: Retrospective study of patients that were admitted to a tertiary care hospital with AMI and newly diagnosed or uncontrolled hypothyroidism (TSH ≥ 10 mIU/L) between 2011–2018. Eligible patients were identified using diagnosis codes for AMI and laboratory values, followed by medical record review. We categorized patients according to treatment status with TH and by degree of hypothyroidism. Clinical outcomes included: 30-day mortality/readmission, bleeding, stroke, arrhythmia, sudden cardiac death, and new or worsening heart failure. Summary statistics and group comparisons are presented. Results: Sixty-four patients were included, their median age was 64 years and 61% (n = 39) were women. Most of the patients (59%) had a documented history of hypothyroidism. Of these, all were restarted on levothyroxine (LT4) during the index admission when compared to patients without a history of hypothyroidism, of which 54% received LT4 treatment (p = 0.001). The median TSH in those treated with LT4 was higher (25 mIU/L) when compared to those who were not (12 mIU/L), (p = 0.007). Patients who received intravenous LT4 had higher TSH levels and other variables suggesting worse clinical presentation, but these differences were not statistically significant. No statistically significant differences were noted on clinical outcomes according to LT4 treatment status. Conclusion: A history of hypothyroidism and the degree of TSH elevation seem to guide the management of hypothyroidism in patients with AMI. The clinical effect of correcting hypothyroidism in this setting requires further evaluation.

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Thyroid stimulating hormone elevation as a predictor of long‐term mortality in patients with acute myocardial infarction

Cited by 29 publications

References 26 publications

Prognostic implications of thyroid hormone alterations in acute coronary syndrome–A systematic review

Prognostic implications of thyroid hormone alterations in acute coronary syndrome–A systematic review

Prognostic value of free triiodothyronine and N-terminal pro-B-type natriuretic peptide for patients with acute myocardial infarction undergoing percutaneous coronary intervention: a prospective cohort study

Management of Hypothyroidism in Patients with Acute Myocardial Infarction

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