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

Suk Min Seo1, Yoon-Seok Koh1, Hun-Jun Park1

  • 1Department of Internal Medicine, Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.

Clinical Cardiology
|August 26, 2018
PubMed

Insights

Elevated thyroid-stimulating hormone (TSH) in acute myocardial infarction (AMI) patients is linked to increased mortality. This finding highlights TSH elevation as a significant predictor of worse clinical outcomes in AMI survivors.

Area of Science:

  • Cardiology
  • Endocrinology
  • Clinical Outcomes Research

Background:

  • Hypothyroidism is linked to hyperlipidemia, endothelial dysfunction, and atherosclerosis.
  • Thyroid-stimulating hormone (TSH) elevation is a key indicator for these conditions.
  • Limited research exists on TSH elevation's impact on long-term outcomes in acute myocardial infarction (AMI) patients.

Purpose of the Study:

  • To investigate the association between TSH elevation and long-term clinical outcomes, specifically mortality, in patients with AMI.
  • To determine if hypothyroidism is associated with higher mortality rates in patients following an acute myocardial infarction.

Main Methods:

  • Analysis of 1977 AMI patients who underwent percutaneous coronary intervention (PCI) with drug-eluting stents, excluding those with hyperthyroidism or central hypothyroidism.
  • Patients were categorized into euthyroid (normal TSH, normal free thyroxine) and hypothyroidism (elevated TSH, normal/low free thyroxine) groups.
  • Comparison of all-cause and cardiac mortality between the two groups over a median follow-up of 3.5 years.

Main Results:

  • The hypothyroidism group (n=131) was older, had more females, and higher rates of atrial fibrillation, stroke, and renal dysfunction compared to the euthyroid group (n=1846).
  • Elevated TSH was significantly associated with higher all-cause mortality (26.0% vs 11.7%, P < 0.0001) and cardiac mortality (9.2% vs 4.6%, P = 0.014).
  • Multivariate analysis identified TSH elevation as a significant predictor of all-cause mortality (adjusted hazard ratio 1.560, P = 0.041).

Conclusions:

  • Patients with acute myocardial infarction and elevated TSH exhibit worse clinical outcomes.
  • TSH elevation independently predicts all-cause mortality in the AMI patient population.
  • These findings underscore the importance of monitoring thyroid function in AMI patients for risk stratification.
Abstract

Keywords:
acute myocardial infarctionhypothyroidismthyroid stimulation hormone

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