Joe Young-Eun, Shin Yu Rim, Kwak Young-Lan, Shim Jae Hang, Shon Young Suk, Shim Jae-Kwang
Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.
Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul 03722, Korea.
J Clin Med. 2022 Aug 27;11(17):5033. doi: 10.3390/jcm11175033.
We retrospectively evaluated the association between preoperative mild thyroid dysfunction (subclinical hypothyroidism [SCH] or low triiodothyronine [T3] syndrome) and outcomes in patients who underwent off-pump coronary surgery (OPCAB). Further, 800 patients (2015−2020) were divided into euthyroid, low T3, and SCH groups. The primary outcome assessed the association with composite endpoints (myocardial infarction, prolonged mechanical ventilation [>24 h], acute kidney injury, and 30-day/in-hospital mortality). The secondary outcome assessed the association with long-term mortality and 10% and 8% of the patients exhibited low T3 and SCH, respectively. Incidences of composite endpoints were significantly higher in the low T3 and SCH groups versus the euthyroid group (50.6%, 45.2%, 17.4%, respectively, p < 0.001). Multivariable regression analysis revealed chronic kidney disease, anemia, EuroSCORE, low T3, and SCH as independent risk factors of composite endpoints. The long-term mortality rate (median follow-up, 30 months) was higher in the low T3 and SCH groups than in the euthyroid group (9.6%, 11.3%, 2.4%, respectively, p < 0.001). In the absence of overt thyroid dysfunction, low T3 and SCH were associated with increased risk of adverse outcomes after OPCAB. Moreover, the adverse influences of low T3 and SCH seem to extend to long-term mortality, implying that routine thyroid function tests may enhance accurate risk stratification.
我们回顾性评估了术前轻度甲状腺功能障碍（亚临床甲状腺功能减退症[SCH]或低三碘甲状腺原氨酸[T3]综合征）与接受非体外循环冠状动脉搭桥术（OPCAB）患者预后之间的关联。此外，将800例患者（2015 - 2020年）分为甲状腺功能正常组、低T3组和SCH组。主要结局评估与复合终点（心肌梗死、机械通气时间延长[>24小时]、急性肾损伤以及30天/住院死亡率）之间的关联。次要结局评估与长期死亡率之间的关联，分别有10%和8%的患者表现为低T3和SCH。低T3组和SCH组的复合终点发生率显著高于甲状腺功能正常组（分别为50.6%、45.2%、17.4%，p<0.001）。多变量回归分析显示，慢性肾病、贫血、欧洲心脏手术风险评估系统（EuroSCORE）、低T3和SCH是复合终点的独立危险因素。低T3组和SCH组的长期死亡率（中位随访30个月）高于甲状腺功能正常组（分别为9.6%、11.3%、2.4%，p<0.001）。在无明显甲状腺功能障碍的情况下，低T3和SCH与OPCAB术后不良结局风险增加相关。此外，低T3和SCH的不良影响似乎延伸至长期死亡率，这意味着常规甲状腺功能检查可能会增强准确的风险分层。
