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Prognostic value of thyroid-stimulating hormone within reference range in patients with coronary artery disease
Gjin Ndrepepa1, Siegmund Braun1, Katharina Mayer1
1Deutsches Herzzentrum München, Technische Universität, Munich, Germany.
Insights
Higher thyroid-stimulating hormone (TSH) levels within the normal range are linked to increased mortality risk in coronary artery disease (CAD) patients after percutaneous coronary intervention (PCI). This study highlights TSH
Area of Science:
- Cardiology
- Endocrinology
- Clinical Research
Background:
- Thyroid-stimulating hormone (TSH) within the upper reference range is associated with cardio-metabolic disorders.
- The prognostic impact of TSH within the reference range for coronary artery disease (CAD) patients post-percutaneous coronary intervention (PCI) is not well-established.
Purpose of the Study:
- To investigate the association between TSH levels within the reference range and the prognosis of CAD patients after PCI.
- To determine the relationship between TSH tertiles and 3-year all-cause mortality in this patient cohort.
Main Methods:
- Included 8010 consecutive CAD patients treated with PCI, all with TSH levels between 0.3 and 4.0 mU/L.
- Assessed 3-year all-cause mortality as the primary outcome.
- Analyzed TSH levels divided into three tertiles.
Main Results:
- The 3-year mortality rate was 10.2%, 9.8%, and 12.3% for the lower, middle, and upper TSH tertiles, respectively (adjusted HR=1.31 per tertile increase).
- TSH levels in the upper tertile were associated with increased 30-day mortality (adjusted HR=2.30) and higher incidence of cardiogenic shock or peri-PCI bleeding.
- No significant association was found between TSH tertiles and mortality from 30 days to 3 years (P=0.603).
Conclusions:
- Elevated TSH levels within the reference range are associated with an increased risk of mortality following PCI in CAD patients.
- The upper range of TSH may serve as a prognostic marker for adverse outcomes after PCI.
Background:
Thyroid-stimulating hormone (TSH) in the upper part of reference range is associated with cardio-metabolic disorders. The association of TSH within reference range with prognosis of patients with coronary artery disease (CAD) after percutaneous coronary intervention (PCI) remains poorly investigated.
Methods:
The study included 8010 consecutive patients with CAD who were treated with PCI. All patients had a TSH level within reference range (0.3 to 4.0 mU/L). The primary outcome was 3-year all-cause mortality.
Results:
TSH tertiles were: 1st tertile (0.3 mU/L to <1.02 mU/L; n=2694), 2nd tertile (1.02 mU/L to <1.67 mU/L; n=2654) and 3rd tertile (1.67 mU/L to 4.00 mU/L; n=2662). The primary outcome (3-year mortality) occurred in 753 patients: 240 deaths in the 1st, 227 deaths in the 2nd and 286 deaths in the 3rd TSH tertile (Kaplan-Meier estimates of mortality 10.2%, 9.8% and 12.3%; adjusted hazard ratio [HR]=1.31, 95% confidence interval [CI] 1.04-1.66 for each tertile increase). TSH level was associated with 30-day mortality (mortality estimates, 1.6% in the 1st, 1.6% in the 2nd and 3.5% in the 3rd TSH tertile; adjusted HR=2.30 [1.33-3.97] for each tertile increase) but not with 30-day to 3-year mortality (mortality estimates, 8.6% in the 1st, 8.2% in the 2nd and 8.8% in the 3rd TSH tertile; P=0.603). The incidence of cardiogenic shock or peri-PCI bleeding was increased in patients in the upper TSH tertile.
Conclusion:
In patients with CAD undergoing PCI, TSH level in the upper part of reference range was associated with increased risk of mortality after PCI.
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