Canpolat Uğur, Turak Osman, Özcan Fırat, Öksüz Fatih, Mendi Mehmet Ali, Yayla Çağrı, Aydoğdu Sinan
Türkiye Yüksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey.
Arch Endocrinol Metab. 2017 Mar-Apr;61(2):130-136. doi: 10.1590/2359-3997000000197. Epub 2016 Aug 25.
Thyroid hormones have both direct and indirect effects on thermogenesis such as modulating vascular smooth muscle cell proliferation. However, the influence of more subtle changes in thyroid hormones on coronary atherosclerosis remains a matter of speculation. Smooth muscle cells play a crucial role in the pathogenesis of in-stent restenosis (ISR). However, the relationship between free thyroxine (fT4) and ISR has not been studied. In the present study, we aimed to assess the role of preprocedural serum fT4 level on the development of ISR in patients undergoing coronary bare metal stent (BMS) implantation.
We enrolled and analyzed clinical, biochemical, and angiographic data from 705 consecutive patients without a history of primary thyroid disease [mean age 60.3 ± 9.3 years, 505 (72%) male]; all patients had undergone BMS implantation and further control coronary angiography owing to stable or unstable angina pectoris. Patients were divided into 3 tertiles based on preprocedural serum fT4 levels.
ISR was observed in 53 (23%) patients in the lowest tertile, 82 (35%) patients in the second tertile, and 107 (46%) patients in the highest fT4 tertile (p < 0.001). Using multiple logistic regression analysis, five characteristics emerged as independent predictors of ISR: diabetes mellitus, smoking, HDL-cholesterol, stent length, and preprocedural serum fT4 level. In receiver operating characteristics curve analysis, fT4 level > 1.23 mg/dL had 70% sensitivity and 73% specificity (AUC: 0.75, p < 0.001) in predicting ISR.
Higher preprocedural serum fT4 is a powerful and independent predictor of BMS restenosis in patients with stable and unstable angina pectoris.
甲状腺激素对产热具有直接和间接影响，比如调节血管平滑肌细胞增殖。然而，甲状腺激素更细微的变化对冠状动脉粥样硬化的影响仍存在争议。平滑肌细胞在支架内再狭窄（ISR）的发病机制中起关键作用。然而，游离甲状腺素（fT4）与ISR之间的关系尚未得到研究。在本研究中，我们旨在评估术前血清fT4水平在接受冠状动脉裸金属支架（BMS）植入的患者发生ISR中的作用。
我们纳入并分析了705例无原发性甲状腺疾病病史患者的临床、生化和血管造影数据[平均年龄60.3±9.3岁，505例（72%）为男性]；所有患者因稳定型或不稳定型心绞痛接受了BMS植入及后续冠状动脉造影检查。根据术前血清fT4水平将患者分为三个三分位数组。
在最低三分位数组中有53例（23%）患者发生ISR，第二三分位数组中有82例（35%）患者发生ISR，fT4最高三分位数组中有107例（46%）患者发生ISR（p<0.001）。通过多因素逻辑回归分析，出现了五个特征作为ISR的独立预测因素：糖尿病、吸烟、高密度脂蛋白胆固醇、支架长度和术前血清fT4水平。在受试者工作特征曲线分析中，fT4水平>1.23mg/dL在预测ISR时具有70%的敏感性和73%的特异性（曲线下面积：0.75，p<0.001）。
术前血清fT4水平较高是稳定型和不稳定型心绞痛患者BMS再狭窄的有力且独立的预测因素。
