Lin Jiun-Yu, Kao Pei-Chi, Tsai Yi-Ting, Chung Chi-Hsiang, Chien Wu-Chien, Lin Chih-Yuan, Lu Chieh-Hua, Tsai Chien-Sung
Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan.
School of Public Health, University of Queensland, Brisbane, QLD 4072, Australia.
J Clin Med. 2022 Jul 4;11(13):3881. doi: 10.3390/jcm11133881.
Background: Some research indicated that hypothyroidism has huge adverse effects for the metabolic, cardiovascular, respiratory, and immune systems. However, there is no confirmed conclusion for the effect of cardiovascular surgery. This cohort study aims to investigate the prognosis of hypothyroidism patient at the age under 65-year-old after coronary artery bypass grafting (CABG) surgery. Method: From the National Health Insurance Research Database of Taiwan, 1586 patients with hypothyroidism who underwent elective CABG surgery were selected, along with 6334 patients who underwent surgery in a ratio of 1:4 sex-, age- and index year-matched controls, who were out of hypothyroidism. We used Cox proportional hazard analysis to compare the rate of 30-day, 5-year mortality, post-operative atrial fibrillation, respiratory complication during an average of 10-year follow-up. Result: Post-CABG patients had more hospital days, which was associated with hypothyroidism, male, DM and higher CCI_R (p < 0.001). Post-CABG patients had more inpatient respiratory complications, which was associated with hypothyroidism (p = 0.041), DM and CCI_R (p < 0.001, p = 0.046), and there was no difference in 1-year respiratory complication, tracheostomy in the same hospital course and within 1 year, repeated PCI, Af, CVVH, cerebral infarction, 30-day and 5-year mortality rate. Conclusions: Hypothyroidism correlates to post-CABG ventilator-related complications and pneumonia, and prolonged hospital days, but no effect on 30-day, 5-year mortality, post-operative atrial fibrillation and cerebral infarction rate. Thyroid function survey might include routinely preoperative survey for CABG outcome prognosis.
一些研究表明,甲状腺功能减退对代谢、心血管、呼吸和免疫系统有巨大的不良影响。然而,关于心血管手术的影响尚无定论。这项队列研究旨在调查65岁以下甲状腺功能减退患者冠状动脉旁路移植术(CABG)后的预后情况。方法:从台湾国民健康保险研究数据库中,选取1586例行择期CABG手术的甲状腺功能减退患者,以及6334例按1:4比例匹配的性别、年龄和索引年份的非甲状腺功能减退对照患者,这些对照患者接受了手术。我们使用Cox比例风险分析比较了平均10年随访期间30天、5年死亡率、术后房颤、呼吸并发症的发生率。结果:CABG术后患者住院天数更多,这与甲状腺功能减退、男性、糖尿病和较高的CCI_R相关(p<0.001)。CABG术后患者有更多的住院呼吸并发症,这与甲状腺功能减退(p=0.041)、糖尿病和CCI_R相关(p<0.001,p=0.046),在1年呼吸并发症、同一住院期间及1年内气管切开、重复PCI、房颤、连续性血液滤过、脑梗死、30天和5年死亡率方面无差异。结论:甲状腺功能减退与CABG术后呼吸机相关并发症和肺炎以及住院天数延长相关,但对30天、5年死亡率、术后房颤和脑梗死发生率无影响。甲状腺功能检查可能包括CABG预后的常规术前检查。