Relationship and prognostic importance of thyroid hormone and N-terminal pro-B-Type natriuretic peptide for patients after acute coronary syndromes: a longitudinal observational study

Abstract

BackgroundAltered thyroid function and increased rates of N-terminal pro-B-Type natriuretic peptide (NT-pro-BNP) are highly prevalent in coronary artery disease (CAD) patients with heart failure, and are associated with unfavorable prognosis. This study was undertaken to examine the relationship and prognostic impact of thyroid hormones, inflammatory biomarkers, and NT-pro-BNP on long-term outcomes in patients after acute coronary syndrome (ACS).MethodsThe study comprised of 642 patients (age 58 ± 10 years, 77 % male) attending an in-patient cardiac rehabilitation program after experiencing ACS. Patients were evaluated for demographic, clinical and CAD risk factors as well as thyroid hormones (e.g., fT3, fT4 level, fT3/fT4 ratio), inflammatory biomarkers (hs-CRP, IL-6) and NT-pro-BNP levels. Data on fT3/fT4 ratio and NT-pro-BNP levels were not normally distributed and were natural-log transformed (ln). Both all-cause (cumulative) and cardiac-related mortality were considered the primary outcomes of interest.ResultsAccording to the Cox model, age, NYHA class, (ln)NT-pro-BNP levels (HR 1.53, 95 % CI 1.13–2.07), fT4 level (HR 1.15, 95 % CI 1.04–1.27), and (ln)fT3/fT4 ratio (HR 0.08, 95 % CI 0.02–0.32) were the most important predictors of all-cause mortality among CAD patients after ACS. Similarly, age, NYHA class, (ln)NT-pro-BNP levels (HR 1.62, 95 % CI 1.11–2.36), fT4 (HR 1.15, 95 % CI 1.02–1.29) and (ln)fT3/fT4 ratio (HR 0.10, 95 % CI 0.02–0.55) independently predicted cardiac-related mortality. Kaplan-Meier analyses provided significant prognostic information with the highest risk for all-cause mortality in the low cut off measures of fT3/fT4 ratio <0.206 and NT-pro-BNP ≥290.4 ng/L (HR 2.03, 95 % CI 1.39–2.96) and fT4 level >12.54 pg/ml (HR = 2.34, 95 % CI 1.05–5.18). There was no association between hs-CRP, IL-6 and mortality in CAD patients after ACS.ConclusionsThyroid hormones (i.e., fT4 level and fT3/fT4 ratio) together with NT-pro-BNP level may be valuable and simple predictors of long-term outcomes of CAD patients after experiencing ACS.

Low T3 syndrome improves risk prediction of in-hospital cardiovascular death in patients with acute myocardial infarction

“…The increased rate of in-hospital CV death in post-AMI patients with LT3S found in our study is consistent with previous reports [1,16,22]. ROC showed AUC of 0.741 with lower levels of fT3 for inhospital CV death.…”

Value of the fT3/fT4 ratio and its combination with the GRACE risk score in predicting the prognosis in euthyroid patients with acute myocardial infarction undergoing percutaneous coronary intervention: a prospective cohort study

“…A decrease in serum T3 has been found to be a predictor of larger myocardial injury size [ 4 , 5 , 7 ], worse cardiac function [ 8 , 9 ], greater thrombus burden [ 10 ], and a poorer prognosis [ 5 , 11 – 14 ] in AMI. A recent study also confirmed the association between free T4 and adverse outcomes in acute coronary syndrome [ 15 ]. Serum T3, which is the most important bioactive thyroid hormone for cardiomyocytes, is mostly produced by the peripheral process of deiodination of T4 [ 6 ].…”

The role of thyroid hormones in acute coronary syndromes: Prognostic value of alterations in thyroid hormones

“…Two further larger studies involving consecutive STEMI patients undergoing primary percutaneous coronary intervention also have related the low T3 syndrome to increased short‐ and long‐term mortality . Moreover, a recent study with patients attending a cardiac rehabilitation program after an ACS also has reported an association of lower fT3 levels with all‐cause mortality …”

“…30,31 Moreover, a recent study with patients attending a cardiac rehabilitation program after an ACS also has reported an association of lower fT3 levels with allcause mortality. 38 Alterations in THs are more evident in critically ill patients. Not surprisingly, a study comparing the thyroid function of patients with resuscitated cardiac arrest due to ACS and patients with uncomplicated AMI showed that the latter group was characterized by a milder form of the low T3 syndrome.…”