Thoracic Clinical College, Tianjin Medical University, Tianjin, China.
The Eighth Department of Cardiology, Tianjin Chest Hospital, Tianjin, China.
Clin Endocrinol (Oxf). 2022 Jan;96(1):70-81. doi: 10.1111/cen.14613. Epub 2021 Oct 12.
Data on the association of subclinical hypothyroidism (SCH) with the severity of coronary artery disease and major adverse cardiovascular and cerebral events (MACCE) in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) after percutaneous coronary intervention (PCI) are limited and conflicting.
We established the baseline rate of SCH and followed the trajectory of thyroid-stimulating hormone (TSH) values during and after hospitalisation for PCI for up to six months and determined whether persistent SCH was associated with the severity of coronary artery disease and MACCE in patients with NSTE-ACS after PCI.
Population-based prospective cohort study.
We included patients with NSTE-ACS who underwent PCI with simple balloon angioplasty or stent implantation for coronary heart disease.
Thyroid function tests of patients before PCI and 1 day, 1 week, 1 and 6 months after PCI were performed. Cases showing transient SCH were excluded. Patients were divided into two groups based on the results of four TSH tests: 0.27-4.2 mIU/L (n = 1472, 89.7%) and >4.2 mIU/L (n = 170, 10.4%). The risk factors for the severity of coronary artery lesions were estimated using multinomial logistic regression analysis. Univariate and multivariate Cox regression analyses were used to study the relationship between TSH and MACCE.
Among 1642 patients, there were 1070 males (65.2%) and 572 females (34.8%), with an average age of 62.5 ± 9.6 years. SCH patients had a wider range of diseased vessels and a higher number of diseased vessels (p < .05). TSH level was an independent risk factor for moderate [odds ratio (OR) = 1.144, 95% confidence interval (95% CI): 1.057-1.237, p = .001] and severe (OR = 1.131, 95% CI: 1.043-1.226, p = .003) coronary artery lesions. After adjusting for covariates, the risk of MACCE [hazard ratio (HR): 4.067, p < .001], nonfatal myocardial infarction (HR: 14.724, p = .003), and unplanned PCI (HR: 5.028, p < .001) were higher in the SCH group than in the euthyroidism group. There were no significant differences in the incidence of heart failure (HR: 6.012, p = .175), nonfatal stroke (HR: 2.039, p = .302), unplanned coronary artery bypass grafting (CABG) (HR: 1.541, p = .57), or cardiac death (HR: 2.704, p = .375) between the two groups.
Preoperative TSH levels and changes in thyroid hormone levels several months post-PCI in NSTE-ACS patients are highly significant in practice. Persistent SCH is associated with severe coronary artery lesions and MACCE, and may be a predictor for evaluating the prognosis of PCI-treated NSTE-ACS patients.
经皮冠状动脉介入治疗（PCI）后非 ST 段抬高型急性冠状动脉综合征（NSTE-ACS）患者亚临床甲状腺功能减退症（SCH）与冠状动脉疾病严重程度和主要不良心血管和脑事件（MACCE）的关系的数据有限且存在争议。
我们确定了 SCH 的基线发生率，并在 PCI 住院期间和之后追踪了促甲状腺激素（TSH）值的变化轨迹，最长可达 6 个月，并确定持续 SCH 是否与 PCI 后 NSTE-ACS 患者的冠状动脉疾病严重程度和 MACCE 相关。
基于人群的前瞻性队列研究。
我们纳入了接受 PCI 的 NSTE-ACS 患者，包括单纯球囊血管成形术或支架植入治疗冠心病。
在 PCI 前和 PCI 后 1 天、1 周、1 个月和 6 个月对患者进行甲状腺功能检查。排除一过性 SCH 病例。根据四次 TSH 检查结果将患者分为两组：0.27-4.2 mIU/L（n=1472，89.7%）和>4.2 mIU/L（n=170，10.4%）。使用多项逻辑回归分析估计冠状动脉病变严重程度的危险因素。使用单变量和多变量 Cox 回归分析研究 TSH 与 MACCE 之间的关系。
在 1642 名患者中，男性 1070 名（65.2%），女性 572 名（34.8%），平均年龄 62.5±9.6 岁。SCH 患者的病变血管范围较广，病变血管数量较多（p<0.05）。TSH 水平是中度（优势比 [OR]：1.144，95%置信区间 [95%CI]：1.057-1.237，p=0.001）和重度（OR：1.131，95%CI：1.043-1.226，p=0.003）冠状动脉病变的独立危险因素。调整协变量后，SCH 组的 MACCE（风险比 [HR]：4.067，p<0.001）、非致死性心肌梗死（HR：14.724，p=0.003）和计划性 PCI（HR：5.028，p<0.001）风险更高。SCH 组心力衰竭（HR：6.012，p=0.175）、非致死性卒中（HR：2.039，p=0.302）、计划性冠状动脉旁路移植术（CABG）（HR：1.541，p=0.57）或心脏死亡（HR：2.704，p=0.375）的发生率与甲状腺功能正常组无显著差异。
NSTE-ACS 患者术前 TSH 水平和 PCI 后几个月甲状腺激素水平的变化在实践中具有重要意义。持续 SCH 与严重冠状动脉病变和 MACCE 相关，可能是评估 PCI 治疗 NSTE-ACS 患者预后的一个预测因子。
