FT3/FT4 Enhances Risk Assessment in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome Undergoing...

Area of Science:

• Cardiology
• Endocrinology
• Clinical Outcomes Research

Background:

• Thyroid hormones, specifically free triiodothyronine (FT3) and free thyroxine (FT4), play crucial roles in cardiovascular function.
• The prognostic value of the FT3/FT4 ratio in euthyroid patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) undergoing percutaneous coronary intervention (PCI) remains underexplored.

Purpose of the Study:

• To investigate the association between the FT3/FT4 ratio and clinical outcomes in euthyroid patients with NSTE-ACS undergoing PCI.
• To determine if the FT3/FT4 ratio can enhance the risk stratification provided by the Global Registry of Acute Coronary Events (GRACE) score.

Main Methods:

• A prospective study included 1448 euthyroid patients with NSTE-ACS who underwent PCI.
• Multivariate Cox regression analysis was employed to assess the risk of adverse events based on FT3/FT4 tertiles.
• The added value of the FT3/FT4 ratio combined with the GRACE score was evaluated using C-statistics, integrated discrimination improvement (IDI), and net reclassification index (NRI).

Main Results:

• Lower FT3/FT4 ratios were significantly associated with an increased risk of stroke (HR 11.380) and major adverse cardiovascular and cerebrovascular events (MACCEs) (HR 3.364).
• The combination of the FT3/FT4 ratio and the GRACE score significantly improved risk assessment metrics (C-statistics, IDI, NRI).

Conclusions:

• The FT3/FT4 ratio is an independent prognostic indicator for long-term MACCE in euthyroid patients with NSTE-ACS undergoing PCI.
• Incorporating the FT3/FT4 ratio into risk assessment models, alongside the GRACE score, can enhance the identification of high-risk patients, potentially guiding post-PCI management strategies.