Thyroid Functions Are Associated with All-Cause Long-Term Mortality in Elderly Patients with ST-Segment Elevation
Ender Emre1, Kaan Hancı2, Mustafa Doğuş Gökçek3
1Departments of Cardiology, Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital, Trabzon, Türkiye.
Insights
Thyroid dysfunction, specifically elevated free thyroxine (fT4), is linked to increased long-term mortality in elderly patients after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.
Area of Science:
- Cardiology
- Endocrinology
- Geriatrics
Background:
- Elderly patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) face significant long-term mortality risks.
- Thyroid function is crucial for cardiovascular health, and its role in mortality post-PCI in the elderly is not fully understood.
Purpose of the Study:
- To investigate the relationship between long-term all-cause mortality and thyroid function in elderly patients who underwent primary PCI for STEMI.
Main Methods:
- Retrospective analysis of 198 elderly patients (≥65 years) who underwent primary PCI for STEMI.
- Patients were divided into mortality groups, and data including angiographic, laboratory, and echocardiographic parameters were analyzed.
- Multivariate analysis and Kaplan-Meier survival analysis were used to identify predictors of mortality.
Main Results:
- Elevated free thyroxine (fT4) levels were identified as an independent predictor of mortality (OR: 2.026, P=0.026).
- A fT4 cut-off value of 0.99 ng/mL predicted mortality with 76% sensitivity and 54% specificity.
- Elevated fT4 was strongly associated with increased long-term mortality (P=0.01) in Kaplan-Meier analysis.
Conclusions:
- Subclinical thyroid dysfunction, particularly elevated fT4, is associated with increased long-term mortality in elderly patients post-primary PCI for STEMI.
- Thyroid function should be considered as a potential prognostic factor in this patient population.
Objective:
Our aim in this study was to show the relationship between long-term all-cause mortality and thyroid functions in the elderly patient group that underwent primary percuta-neous coronary intervention with the diagnosis of ST-segment elevation myocardial infarction.
Methods:
Two-hundred seventy patients over 65 years of age who underwent primary percutaneous coronary intervention with the diagnosis of ST-segment elevation myocardial infarction were analyzed retrospectively. After applying the exclusion criteria, 198 patients were included in the study. The patients were divided into 2 groups according to their out-of-hospital mortality status. Angiographic, laboratory, echocardiographic, and electrocardiographic data were analyzed.
Results:
The mean age of 198 patients in the study was 72.5 ± 6.6 years, and the median follow-up time was 101.7 months. Age was higher in the deceased group (70.4 ± 5.4 vs. 74.5 ± 6.9, P < 0.001). In multivariate analysis, age (odds ratio: 1.59, P = 0.003), insulin (odds ratio: 2.561, P = 0.016), angina balloon time (odds ratio: 1.134, P = 0.002), number of serious stenoses (odds ratio: 1.702, P = 0.003), creatinine (odds ratio: 3.043, P < 0.001), and fT4 (odds ratio: 2.026, P = 0.026) were determined as independent predictors of mortality. The fT4 level was correlated with the uric acid level (R: 0.182, P = 0.02) and the fT3 level was correlated with albumin (R: -0.253, P = 0.001) and creatinine (R: -0.224, P = 0.003) levels. A fT4 level cutoff value of 0.99 ng/mL had a sensitivity of 76%, a specificity of 54%, and an area under the curve of 0.675 in predicting mortality. In Kaplan-Meier analysis, fT4 elevation was strongly associated with mortality (P = 0.01).
Conclusion:
In our study, subclinical values in thyroid functions were found to be associated with increased mortality, apart from known factors in elderly patients who underwent primary PTCA with the diagnosis of ST-segment elevation myocardial infarction.
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