游离三碘甲状腺原氨酸在接受经皮冠状动脉介入治疗的急性冠状动脉综合征患者中的预测价值
Predictive Value of Free Triiodothyronine in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention.
作者信息
Yang Zhi Qiang, Ma Xiao Teng, Shao Qiao Yu, Li Qiu Xuan, Wang Yu Fei, Liang Jing, Shen Hua, Liu Xiao Li, Shi Dong Mei, Zhou Yu Jie, Fang Zhe, Wang Zhi Jian
机构信息
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, 100029 Beijing, China.
Department of Cardiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, 330006 Nanchang, Jiangxi, China.
出版信息
Rev Cardiovasc Med. 2022 Jun 24;23(7):230. doi: 10.31083/j.rcm2307230. eCollection 2022 Jul.
BACKGROUND
Homeostasis of thyroid hormones has significant effects on the cardiovascular system. The aim of this study was to investigate the association between free triiodothyronine (FT3) and adverse cardiovascular events in patients with acute coronary syndrome (ACS) who were undergoing percutaneous coronary intervention (PCI).
METHODS
A total of 1701 patients with ACS undergoing PCI were included in this study. All patients were divided into three groups according to the tertiles of FT3 level: the lowest tertile (FT3 4.51 pmol/L), the middle tertile (4.51 pmol/L FT3 4.89 pmol/L) and the highest tertile group (FT3 4.89 pmol/L). The primary study endpoint was a composite of major adverse cardiovascular events (MACE), which included all-cause death, ischemic stroke, myocardial infarction, or unplanned repeat revascularization.
RESULTS
During a median follow-up period of 927 days, 349 patients had at least one event. Compared with patients with the highest tertile, those with the lowest tertile had a significantly higher incidence of MACE, all-cause death, MI, ischemic stroke and repeat revascularization (all values 0.05). In the multivariate Cox regression analysis, the middle tertile had similar risk of MACE (HR = 0.986, 95% CI 0.728-1.336, = 0.929) as the highest tertile, but the patients with the lowest tertile had a 92.9% higher risk of MACE (HR = 1.929, 95% CI 1.467-2.535, 0.001). There was a non-linear relationship between FT3 and MACE and unplanned repeat revascularization (all values for non-linear association 0.001). Adding the tertiles of FT3 level into the baseline model yielded a significant improvement in discrimination for predicting MACE ( AUC = 0.013, = 0.025).
CONCLUSIONS
A significantly reduced FT3 level was independently associated with a worse prognosis in patients with ACS undergoing PCI.
背景
甲状腺激素的稳态对心血管系统有显著影响。本研究的目的是调查接受经皮冠状动脉介入治疗（PCI）的急性冠状动脉综合征（ACS）患者中游离三碘甲状腺原氨酸（FT3）与不良心血管事件之间的关联。
方法
本研究共纳入1701例接受PCI的ACS患者。所有患者根据FT3水平的三分位数分为三组：最低三分位数组（FT3＜4.51 pmol/L）、中间三分位数组（4.51 pmol/L≤FT3＜4.89 pmol/L）和最高三分位数组（FT3≥4.89 pmol/L）。主要研究终点是主要不良心血管事件（MACE）的复合终点，包括全因死亡、缺血性卒中、心肌梗死或计划外再次血管重建。
结果
在中位随访期927天内，349例患者至少发生了一次事件。与最高三分位数组患者相比，最低三分位数组患者的MACE、全因死亡、心肌梗死、缺血性卒中和再次血管重建的发生率显著更高（所有P值＜0.05）。在多变量Cox回归分析中，中间三分位数组发生MACE的风险（HR = 0.986，95%CI 0.728 - 1.336，P = 0.929）与最高三分位数组相似，但最低三分位数组患者发生MACE的风险高92.9%（HR = 1.929，95%CI 1.467 - 2.535，P＜0.001）。FT3与MACE及计划外再次血管重建之间存在非线性关系（所有非线性关联的P值＜0.001）。将FT3水平的三分位数纳入基线模型可显著改善预测MACE的判别能力（ΔAUC = 0.013，P = 0.025）。
结论
FT3水平显著降低与接受PCI的ACS患者预后较差独立相关。
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