Zhang Ming, Sara Jaskanwal D S, Matsuzawa Yasushi, Gharib Hossein, Bell Malcolm R, Gulati Rajiv, Lerman Lilach O, Lerman Amir
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
Eur Heart J. 2016 Jul 7;37(26):2055-65. doi: 10.1093/eurheartj/ehv737. Epub 2016 Jan 12.
The aim of this study was to investigate the association between hypothyroidism and major adverse cardiovascular and cerebral events (MACCE) in patients undergoing percutaneous coronary intervention (PCI).
Two thousand four hundred and thirty patients who underwent PCI were included. Subjects were divided into two groups: hypothyroidism (n = 686) defined either as a history of hypothyroidism or thyroid-stimulating hormone (TSH) ≥5.0 mU/mL, and euthyroidism (n = 1744) defined as no history of hypothyroidism and/or 0.3 mU/mL ≤ TSH < 5.0 mU/mL. Patients with hypothyroidism were further categorized as untreated (n = 193), or those taking thyroid replacement therapy (TRT) with adequate replacement (0.3 mU/mL ≤ TSH < 5.0 mU/mL, n = 175) or inadequate replacement (TSH ≥ 5.0 mU/mL, n = 318). Adjusted hazard ratios (HRs) were calculated using Cox proportional hazards models. Median follow-up was 3.0 years (interquartile range, 0.5-7.0). After adjustment for covariates, the risk of MACCE and its constituent parts was higher in patients with hypothyroidism compared with those with euthyroidism (MACCE: HR: 1.28, P = 0.0001; myocardial infarction (MI): HR: 1.25, P = 0.037; heart failure: HR: 1.46, P = 0.004; revascularization: HR: 1.26, P = 0.0008; stroke: HR: 1.62, P = 0.04). Compared with untreated patients or those with inadequate replacement, adequately treated hypothyroid patients had a lower risk of MACCE (HR: 0.69, P = 0.005; HR: 0.78, P = 0.045), cardiac death (HR: 0.43, P = 0.008), MI (HR: 0.50, P = 0.0004; HR: 0.60, P = 0.02), and heart failure (HR: 0.50, P = 0.02; HR: 0.52, P = 0.017).
Hypothyroidism is associated with a higher incidence of MACCE compared with euthyroidism in patients undergoing PCI. Maintaining adequate control on TRT is beneficial in preventing MACCE.
本研究旨在调查接受经皮冠状动脉介入治疗(PCI)的患者甲状腺功能减退与主要不良心血管和脑血管事件(MACCE)之间的关联。
纳入2430例接受PCI的患者。受试者分为两组:甲状腺功能减退组(n = 686),定义为有甲状腺功能减退病史或促甲状腺激素(TSH)≥5.0 mU/mL;甲状腺功能正常组(n = 1744),定义为无甲状腺功能减退病史且0.3 mU/mL≤TSH<5.0 mU/mL。甲状腺功能减退患者进一步分为未治疗组(n = 193)、接受甲状腺替代治疗(TRT)且替代充分(0.3 mU/mL≤TSH<5.0 mU/mL,n = 175)或替代不充分(TSH≥5.0 mU/mL,n = 318)。使用Cox比例风险模型计算调整后的风险比(HRs)。中位随访时间为3.0年(四分位间距,0.5 - 7.0)。在对协变量进行调整后,与甲状腺功能正常的患者相比,甲状腺功能减退患者发生MACCE及其组成部分的风险更高(MACCE:HR:1.28,P = 0.0001;心肌梗死(MI):HR:1.25,P = 0.037;心力衰竭:HR:1.46,P = 0.004;血运重建:HR:1.26,P = 0.0008;中风:HR:1.62,P = 0.04)。与未治疗患者或替代不充分的患者相比,接受充分治疗的甲状腺功能减退患者发生MACCE的风险较低(HR:0.69,P = 0.005;HR:0.78,P = 0.045),心脏死亡风险较低(HR:0.43,P = 0.008),MI风险较低(HR:0.50,P = 0.0004;HR:0.60,P = 0.02),心力衰竭风险较低(HR:0.50,P = 0.02;HR:0.52,P = 0.017)。
在接受PCI的患者中,与甲状腺功能正常相比,甲状腺功能减退与MACCE的发生率较高相关。维持TRT的充分控制对预防MACCE有益。