Dell'Aquila Michele, Rossi Camilla S, Caldonazo Tulio, Cancelli Gianmarco, Harik Lamia, Soletti Giovanni J, An Kevin R, Leith Jordan, Kirov Hristo, Ibrahim Mudathir, Demetres Michelle, Dimagli Arnaldo, Rahouma Mohamed, Gaudino Mario
Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY.
Department of Cardiothoracic Surgery, Friedrich Schiller University, Jena, Germany.
JTCVS Open. 2024 Feb 19;18:64-79. doi: 10.1016/j.xjon.2024.02.009. eCollection 2024 Apr.
Subclinical hypothyroidism (SCH) is associated with major adverse cardiovascular events. Despite the recognized negative impact of SCH on cardiovascular health, research on cardiac postoperative outcomes with SCH has yielded conflicting results, and patients are not currently treated for SCH before cardiac surgery procedures.
We performed a study-level meta-analysis on the impact of SCH on patients undergoing nonurgent cardiac surgery, including coronary artery bypass grafting and valve and aortic surgery. The primary outcome was operative mortality. Secondary outcomes were hospital length of stay (LOS), intensive care unit (ICU) stay, postoperative atrial fibrillation (POAF), intra-aortic balloon pump (IABP) use, renal complications, and long-term all-cause mortality.
Seven observational studies, with a total of 3445 patients, including 851 [24.7%] diagnosed with SCH and 2594 [75.3%] euthyroid patients) were identified. Compared to euthyroid patients, the patients with SCH had higher rates of operative mortality (odds ratio [OR], 2.57; 95% confidence interval [CI], 1.09-6.04; = .03), prolonged hospital LOS (standardized mean difference, 0.32; 95% CI, 0.02-0.62; = .04), a higher rate of renal complications (OR, 2.53; 95% CI, 1.74-3.69; < .0001), but no significant differences in ICU stay, POAF, or IABP use. At mean follow-up of 49.3 months, the presence of SCH was associated with a higher rate of all-cause mortality (incidence rate ratio, 1.82; 95% CI, 1.18-2.83; = .02).
Patients with SCH have higher operative mortality, prolonged hospital LOS, and increased renal complications after cardiac surgery. Achieving and maintaining a euthyroid state prior to and after cardiac surgery procedures might improve outcomes in these patients.
亚临床甲状腺功能减退（SCH）与主要不良心血管事件相关。尽管SCH对心血管健康的负面影响已得到公认，但关于SCH患者心脏术后结局的研究结果却相互矛盾，目前在心脏手术前患者并未因SCH接受治疗。
我们对SCH对接受非急诊心脏手术患者（包括冠状动脉搭桥术、瓣膜手术和主动脉手术）的影响进行了研究水平的荟萃分析。主要结局是手术死亡率。次要结局包括住院时间（LOS）、重症监护病房（ICU）住院时间、术后房颤（POAF）、主动脉内球囊反搏（IABP）的使用、肾脏并发症以及长期全因死亡率。
共纳入7项观察性研究，总计3445例患者，其中851例（24.7%）诊断为SCH，2594例（75.3%）甲状腺功能正常。与甲状腺功能正常的患者相比，SCH患者的手术死亡率更高（比值比[OR]，2.57；95%置信区间[CI]，1.09 - 6.04；P = 0.03），住院LOS延长（标准化均数差，0.32；95% CI，0.02 - 0.62；P = 0.04），肾脏并发症发生率更高（OR，2.53；95% CI，1.74 - 3.69；P < 0.0001），但在ICU住院时间、POAF或IABP使用方面无显著差异。在平均49.3个月的随访中，SCH的存在与全因死亡率较高相关（发病率比，1.82；95% CI，1.18 - 2.83；P = 0.02）。
SCH患者心脏手术后手术死亡率更高、住院LOS延长且肾脏并发症增加。在心脏手术前后实现并维持甲状腺功能正常状态可能会改善这些患者的结局。
