The Association between Thyroid-Stimulating Hormone and Long-Term Outcomes in Patients with ST Segment Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention

Abstract

Objective Thyroid hormones are closely related to the cardiovascular system. Our study aimed to explore the impact of admission thyroid-stimulating hormone (TSH) levels on long-term outcomes in patients with acute ST segment elevation myocardial infarction (STEMI) by detailed stratifications of TSH. Methods Consecutive STEMI patients admitted to our hospital were divided into four groups: Group 1 (TSH <0.35 mIU/L), Group 2 (TSH 0.35–1.0 mIU/L), Group 3 (TSH 1.0–3.5 mIU/L), and Group 4 (TSH >3.5 mIU/L). The primary endpoint was all-cause mortality during follow-up, and the median follow-up was 2.5 years. Cox proportional hazard regression models were performed to identify the prognostic value of TSH. Results A total of 1186 patients were included. Group 4 was presented with higher systolic and diastolic blood pressure (all P < 0.001), and Group 1 had more patients complicated by heart failure (Killip class >I, P = 0.014). During follow-up, 138 deaths occurred. Patients in Group 4 had the worst long-term outcomes (P < 0.001). The cumulative survival in Group 4 was remarkably lower (Log rank P < 0.001), whereas the other three groups were comparable (Log rank P = 0.365). Through Cox regression analysis, only TSH >3.5 mIU/L was identified as an independent risk factor for long-term mortality after STEMI. Conclusion Only TSH elevation beyond the normal range was associated with worse long-term prognosis in STEMI patients, while high-normal TSH or reduced TSH did not alter long-term prognosis of STEMI patients. TSH >3.5 mIU/L was an independent risk factor for long-term mortality in STEMI.

Association of Mild Thyroid Dysfunction and Adverse Prognosis Among Chinese Patients With Acute ST Segment Elevation Myocardial Infarction

“…( 27 ) firstly found that SHyper was associated with an increased risk of cardiac and overall mortality in 1,026 patients with acute cardiac diseases during a 30-month follow-up, whereas only 285 of them were caused by AMI. In contrast, in a recent retrospective study with a median 2.5-year follow-up, no relation was observed between the decreased TSH and poor clinical outcomes in the population of STEMI; however, studied subjects were not further stratified by FT3 or FT4 in this study ( 14 ). The ThyrAMI-1 study also showed that AMI patients in the SHyper group did not alter all-cause mortality relative to those in the euthyroid group ( 28 ).…”

“…For example, Zhu et al. ( 14 ) reported that increased TSH above the reference range was related to worse long-term prognosis and TSH > 3.5 mIU/L worked as an independent predictor for worse 2.5-year mortality in STEMI patients. Soeiro et al.…”

Short-term outcomes among patients with subclinical hypothyroidism undergoing primary percutaneous coronary intervention

“…31 Moreover, long-term mortality was also significantly higher. [31][32][33] In contrast to these findings, another study found no difference in LV ejection function among individuals with the acute coronary syndrome. 34 In the current study, SCH was associated with a higher risk of acute kidney injury than euthyroid patients.…”

Establishment and validation of nomogram model for predicting major adverse cardiac events in patients with acute ST-segment elevation myocardial infarction based on glycosylated hemoglobin A1c to apolipoprotein A1 ratio: An observational study

“…Low systolic blood pressure is typically accompanied by low diastolic blood pressure, which not only reflects a reduction in cardiac function, but also leads to insufficient coronary perfusion reserve, thereby aggravating myocardial ischemia. [ 40 ] A study by Shiraishi J et al [ 41 ] found that low diastolic blood pressure was linked to higher risk of cardiovascular events and death compared to peripheral diastolic blood pressure of 80–89 mm Hg.…”