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Prevalence, predictors and outcomes of thyroid dysfunction in patients with acute myocardial infarction: the
A Jabbar1,2, L Ingoe3, H Thomas4
1Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE1 3BZ, UK.
Insights
Thyroid dysfunction is common in acute myocardial infarction (AMI) patients. Low T3 syndrome (LT3S) was linked to increased mortality post-AMI, while subclinical hypothyroidism and hyperthyroidism showed no significant mortality increase.
Area of Science:
- Cardiology
- Endocrinology
- Internal Medicine
Background:
- Thyroid dysfunction is a known risk factor for adverse outcomes in cardiac patients.
- Understanding thyroid status in acute myocardial infarction (AMI) is crucial for patient management.
Purpose of the Study:
- To determine the prevalence of thyroid dysfunction in patients with AMI.
- To identify predictors of thyroid dysfunction in this population.
- To analyze the outcomes associated with different types of thyroid dysfunction post-AMI.
Main Methods:
- Prospective, multicentre observational study (ThyrAMI-1 cohort).
- Recruited consecutive patients with STEMI and NSTEMI without prior thyroid disease.
- Assessed thyroid profiles, biochemistry, and demographics within 12 hours of admission.
- Used multivariable logistic regression and Cox proportional hazards analyses for predictors and mortality.
Main Results:
- Prevalence: 17.3% subclinical hypothyroidism (SCH), 1.2% subclinical hyperthyroidism (SHyper), 1.3% low T3 syndrome (LT3S).
- Predictors for SCH included age, female sex, TPOAb, creatinine, and early morning sampling.
- LT3S was associated with higher all-cause mortality (aHR 2.02), while SCH and SHyper were not significantly linked to increased mortality.
Conclusions:
- Thyroid dysfunction is prevalent upon hospital admission for AMI.
- Specific factors predict different types of thyroid dysfunction in AMI patients.
- Low T3 syndrome is associated with increased post-AMI mortality, warranting further investigation into treatment efficacy.
Purpose:
Thyroid dysfunction in patients with cardiac disease is associated with worse outcomes. This study aimed to evaluate the prevalence and analyse predictors and outcomes of thyroid dysfunction in patients presenting with an acute myocardial infarction (AMI).
Methods:
A prospective multicentre observational study of patients recruited from six acute hospitals within the North of England. Consecutive patients without previous thyroid disease presenting with both ST-elevation AMI (STEMI) and non-ST-elevation AMI (NSTEMI) were recruited to the Thyroxine in Acute Myocardial Infarction 1 (ThyrAMI-1) cohort study between December 2014 and 2016. Thyroid profile, standard biochemistry measurements and demographic information were obtained within 12 h of admission to hospital. Multivariable logistic regression analyses were performed to assess the predictors of thyroid dysfunction and Cox proportional hazards analyses were utilised to compare all-cause mortality by categories of thyroid dysfunction up to June 2019.
Results:
Of the 1802 participants analysed, 1440 (79.9%) were euthyroid, 312 (17.3%) had subclinical hypothyroidism (SCH), 22 (1.2%) had subclinical hyperthyroidism (SHyper) and 25 (1.3%) had low T3 syndrome (LT3S). Predictors for SCH were increasing age, female sex, higher thyroid peroxidase antibody (TPOAb) levels, higher serum creatinine levels and early morning sampling time (between 00:01-06:00 h). The predictors of SHyper were lower body mass index and afternoon sampling time (between 12:01 and 18:00 h). Predictors of LT3S were increasing age, higher creatinine levels and presence of previous ischaemic heart disease. Compared to the euthyroid group, patients with LT3S had higher all-cause mortality; adjusted hazard ratio (95% CI) of 2.02 (1.03-3.95), p = 0.04, whereas those with SCH and SHyper did not exhibit significantly increased mortality; adjusted hazard ratios (95% CI) of 1.05 (0.74-1.49), p = 0.79 and 0.27 (0.04-1.95), p = 0.19, respectively.
Conclusions:
Thyroid dysfunction is common in AMI patients on admission to hospital and our data provide an understanding regarding which factors might influence thyroid dysfunction in these patients. Furthermore, the negative association between LT3S and increased mortality post-AMI has once again been highlighted by this study. More research is required to assess if treatment of thyroid dysfunction improves clinical outcomes.
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