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Prognostic Value of Normal Thyroid Stimulating Hormone in Long-Term Mortality in Patients With STEMI
Lijie Sun1, Keling Xiao1, Zupei Miao1
1Department of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China.
Insights
Higher normal thyroid stimulating hormone (TSH) levels are linked to increased long-term mortality in ST-segment elevation myocardial infarction (STEMI) patients. This finding suggests TSH may help identify STEMI patients with a poorer prognosis.
Area of Science:
- Cardiology
- Endocrinology
- Internal Medicine
Background:
- Thyroid stimulating hormone (TSH) levels, even within the normal range, are implicated in cardio-metabolic disorders and cardiovascular system effects.
- The prognostic significance of normal TSH levels in patients with ST-segment elevation myocardial infarction (STEMI) requires further investigation.
Purpose of the Study:
- To evaluate the prognostic value of normal TSH levels on long-term mortality in patients who have experienced STEMI.
- To determine if TSH levels within the normal range can predict adverse outcomes in STEMI patients.
Main Methods:
- A cohort of 1,203 STEMI patients with normal TSH levels (0.55-4.78 μIU/ml) were analyzed.
- Patients were stratified into tertiles based on TSH levels to compare all-cause mortality and cardiac death.
- Cox proportional hazards regression and restricted cubic splines were used to assess TSH's association with mortality.
Main Results:
- Patients in the highest TSH tertile exhibited significantly higher all-cause mortality (20.1%) and cardiac death (15.4%) compared to lower tertiles.
- TSH was identified as an independent predictor of long-term all-cause mortality (HR: 1.248).
- This association was significant for all-cause mortality in patients not receiving emergency reperfusion therapy.
Conclusions:
- Elevated TSH levels, even within the normal range, are associated with increased long-term mortality in STEMI patients.
- Normal TSH levels may serve as an additional marker for identifying STEMI patients at higher risk of mortality.
- Further research could explore the clinical implications of managing TSH within the normal range in STEMI patients.
Background:
Although within the normal range, thyroid stimulating hormone (TSH) levels are associated with cardio-metabolic disorders and have an effect on the cardiovascular system. The aim of our study was to assess the prognostic value of normal TSH on long-term mortality in patients with ST-segment elevation myocardial infarction (STEMI).
Methods:
Consecutive STEMI patients who had a TSH level within the normal range (0.55-4.78 μIU/ml) were enrolled from November 2013 to December 2018. Patients were stratified into three groups depending on the tertile of TSH level, and all-cause mortality and cardiac death were compared. TSH concentrations associated with risk of all-cause mortality were evaluated in a continuous scale (restricted cubic splines) and the Cox proportional hazards regression model.
Results:
A total of 1,203 patients with STEMI were eligible for analysis. During a median follow-up of 39 months, patients in the 3rd tertile group had higher all-cause mortality (20.1% vs. 12.2% and 14.3%, p = 0.006) and cardiac death (15.4% vs. 7.7% and 12.3%, p = 0.001) as compared to the 1st and 2nd tertile groups. The Cox proportional hazards model showed that TSH was an independent predictor on long-term all-cause mortality (HR: 1.248, 95% CI: 1.046-1.490, p = 0.014). However, subgroup analysis indicated that TSH (HR: 1.313, 95% CI: 1.063-1.623, p = 0.012) was only significantly associated with long-term all-cause mortality in the patients without emergency reperfusion therapy. Restricted cubic spline analyses showed a linear relationship between TSH concentrations and all-cause mortality (P for non-linearity = 0.659).
Conclusions:
A Higher TSH level - even in a normal range is associated with long-term mortality in patients with STEMI, proposing an additional indication to identify STEMI patients with poor prognosis.
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