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Unknown Subclinical Hypothyroidism and In-Hospital Outcomes and Short- and Long-Term All-Cause Mortality among ST Segment Elevation Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention.

Authors
  • Izkhakov, Elena1, 2
  • Zahler, David2, 3
  • Rozenfeld, Keren-Lee2, 3
  • Ravid, Dor2, 3
  • Banai, Shmuel2, 3
  • Topilsky, Yan2, 3
  • Stern, Naftali1, 2
  • Greenman, Yona1, 2
  • Shacham, Yacov2, 3
  • 1 Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel. , (Israel)
  • 2 Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv 6997801, Israel. , (Israel)
  • 3 Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel. , (Israel)
Type
Published Article
Journal
Journal of Clinical Medicine
Publisher
MDPI AG
Publication Date
Nov 26, 2020
Volume
9
Issue
12
Identifiers
DOI: 10.3390/jcm9123829
PMID: 33256094
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Subclinical hypothyroidism (SCH) is defined as an elevated serum thyroid-stimulating hormone (TSH) level with a normal serum-free thyroxine (FT4) level. SCH has been associated with an increased risk of adverse cardiovascular outcomes. We investigated possible associations of unknown SCH with in-hospital outcomes and short- and long-term all-cause mortality in a large cohort of patients with ST segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). This retrospective, single-center observational study evaluated the TSH and FT4 levels of 1593 STEMI patients with no known history of hypothyroidism or thyroid replacement treatment who were admitted to the coronary care unit and underwent PCI between 1/2008 and 8/2017. SCH was defined as TSH levels ≥ 5 mU/mL in the presence of normal FT4 levels. Unknown SCH was detected in 68/1593 (4.2%) STEMI patients. These patients had significantly worse in-hospital outcomes compared to patients without SCH, including higher rates of acute kidney injury (p = 0.003) and left ventricular ejection fraction ≤ 40% (p = 0.03). Moreover, 30-day mortality (p = 0.02) and long-term (mean 4.2 ± 2.3 years) mortality (p = 0.007) were also significantly higher in patients with SCH. The thyroid function of STEMI patients should be routinely tested before they undergo a planned PCI procedure.

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