Razvi Salman, Jabbar Avais, Bano Arjola, Ingoe Lorna, Carey Peter, Junejo Shahid, Thomas Honey, Addison Caroline, Austin David, Greenwood John P, Zaman Azfar G
Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
Department of Endocrinology, Gateshead Health NHS Foundation Trust, Gateshead, UK.
Eur Thyroid J. 2022 Feb 9;11(2):e210085. doi: 10.1530/ETJ-21-0085.
To study the relationship between serum-free T3 (FT3), C-reactive protein (CRP) and all-cause mortality in patients with acute myocardial infarction (AMI).
Prospective multicentre longitudinal cohort study.
Between December 2014 and December 2016, thyroid function and CRP were analysed in AMI (both ST-elevation (STEMI) and non-ST-elevation) patients from the Thyroxine in Acute Myocardial Infarction study. The relationship of FT3 and CRP at baseline with all-cause mortality up to June 2020 was assessed. Mediation analysis was performed to evaluate if CRP mediated the relationship between FT3 and mortality.
In 1919 AMI patients (29.2% women, mean (s.d.) age: 64.2 (12.1) years and 48.7% STEMI) followed over a median (interquartile range) period of 51 (46-58) months, there were 277 (14.4%) deaths. Overall, lower serum FT3 and higher CRP levels were associated with higher risk of mortality. When divided the patients into tertiles based on the levels of FT3 and CRP; the group with the lowest FT3 and highest CRP levels had a 2.5-fold increase in mortality risk (adjusted hazard ratio (95% CI) of 2.48 (1.82-3.16)) compared to the group with the highest FT3 and lowest CRP values. CRP mediated 9.8% (95% CI: 6.1-15.0%) of the relationship between FT3 and mortality.
In AMI patients, lower serum FT3 levels on admission are associated with a higher mortality risk, which is partly mediated by inflammation. Adequately designed trials to explore the potential benefits of T3 in AMI patients are required.
研究急性心肌梗死（AMI）患者血清游离三碘甲状腺原氨酸（FT3）、C反应蛋白（CRP）与全因死亡率之间的关系。
前瞻性多中心纵向队列研究。
在2014年12月至2016年12月期间，对急性心肌梗死甲状腺素研究中的AMI患者（包括ST段抬高型心肌梗死（STEMI）和非ST段抬高型心肌梗死）进行甲状腺功能和CRP分析。评估基线时FT3和CRP与截至2020年6月的全因死亡率之间的关系。进行中介分析以评估CRP是否介导了FT3与死亡率之间的关系。
在1919例AMI患者中（女性占29.2%，平均（标准差）年龄：64.2（12.1）岁，STEMI占48.7%），随访时间中位数（四分位间距）为51（46 - 58）个月，有277例（14.4%）死亡。总体而言，血清FT3水平较低和CRP水平较高与较高的死亡风险相关。根据FT3和CRP水平将患者分为三分位数；与FT3水平最高且CRP水平最低的组相比，FT3水平最低且CRP水平最高的组死亡风险增加了2.5倍（调整后风险比（95%CI）为2.48（1.82 - 3.16））。CRP介导了FT3与死亡率之间关系的9.8%（95%CI：6.1 - 15.0%）。
在AMI患者中，入院时血清FT3水平较低与较高的死亡风险相关，这部分是由炎症介导的。需要进行设计充分的试验来探索T3对AMI患者的潜在益处。
