Clinical outcomes of patients with hypothyroidism undergoing percutaneous coronary intervention
Ming Zhang1, Jaskanwal D S Sara2, Yasushi Matsuzawa2
1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Insights
Hypothyroidism increases the risk of major adverse cardiovascular and cerebral events (MACCE) after percutaneous coronary intervention (PCI). Adequate thyroid replacement therapy significantly reduces this risk, improving patient outcomes.
Area of Science:
- Cardiology
- Endocrinology
- Clinical Research
Background:
- Hypothyroidism is a common endocrine disorder.
- Percutaneous coronary intervention (PCI) is a standard procedure for coronary artery disease.
- The association between hypothyroidism and adverse cardiovascular events post-PCI requires further investigation.
Purpose of the Study:
- To investigate the association between hypothyroidism and major adverse cardiovascular and cerebral events (MACCE) in patients undergoing PCI.
- To evaluate the impact of thyroid replacement therapy (TRT) on MACCE risk in hypothyroid patients post-PCI.
Main Methods:
- A cohort of 2,430 patients undergoing PCI was analyzed.
- Patients were classified as hypothyroid (n=686) or euthyroid (n=1744) based on medical history and thyroid-stimulating hormone (TSH) levels.
- Hypothyroid patients were further categorized by treatment status: untreated, adequately treated, or inadequately treated with TRT.
- Cox proportional hazards models were used to calculate adjusted hazard ratios (HRs) for MACCE over a median follow-up of 3.0 years.
Main Results:
- Hypothyroidism was associated with a significantly higher risk of MACCE (HR: 1.28, P=0.0001) compared to euthyroidism.
- Specific MACCE components including myocardial infarction, heart failure, and stroke were also elevated in hypothyroid patients.
- Adequately treated hypothyroid patients demonstrated a lower risk of MACCE (HR: 0.69, P=0.005) and cardiac death compared to untreated or inadequately treated patients.
Conclusions:
- Hypothyroidism is an independent risk factor for MACCE in patients undergoing PCI.
- Effective management of hypothyroidism with TRT is crucial for reducing cardiovascular and cerebral event risk post-PCI.
- Optimizing thyroid hormone levels in hypothyroid patients undergoing PCI can improve clinical outcomes.
Aims:
The aim of this study was to investigate the association between hypothyroidism and major adverse cardiovascular and cerebral events (MACCE) in patients undergoing percutaneous coronary intervention (PCI).
Methods And Results:
Two thousand four hundred and thirty patients who underwent PCI were included. Subjects were divided into two groups: hypothyroidism (n = 686) defined either as a history of hypothyroidism or thyroid-stimulating hormone (TSH) ≥5.0 mU/mL, and euthyroidism (n = 1744) defined as no history of hypothyroidism and/or 0.3 mU/mL ≤ TSH < 5.0 mU/mL. Patients with hypothyroidism were further categorized as untreated (n = 193), or those taking thyroid replacement therapy (TRT) with adequate replacement (0.3 mU/mL ≤ TSH < 5.0 mU/mL, n = 175) or inadequate replacement (TSH ≥ 5.0 mU/mL, n = 318). Adjusted hazard ratios (HRs) were calculated using Cox proportional hazards models. Median follow-up was 3.0 years (interquartile range, 0.5-7.0). After adjustment for covariates, the risk of MACCE and its constituent parts was higher in patients with hypothyroidism compared with those with euthyroidism (MACCE: HR: 1.28, P = 0.0001; myocardial infarction (MI): HR: 1.25, P = 0.037; heart failure: HR: 1.46, P = 0.004; revascularization: HR: 1.26, P = 0.0008; stroke: HR: 1.62, P = 0.04). Compared with untreated patients or those with inadequate replacement, adequately treated hypothyroid patients had a lower risk of MACCE (HR: 0.69, P = 0.005; HR: 0.78, P = 0.045), cardiac death (HR: 0.43, P = 0.008), MI (HR: 0.50, P = 0.0004; HR: 0.60, P = 0.02), and heart failure (HR: 0.50, P = 0.02; HR: 0.52, P = 0.017).
Conclusion:
Hypothyroidism is associated with a higher incidence of MACCE compared with euthyroidism in patients undergoing PCI. Maintaining adequate control on TRT is beneficial in preventing MACCE.
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