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Prevalence, Predictors and Outcomes of Thyroid Dysfunction in patients with Acute Myocardial Infarction – the ThyrAMI-1 Study

Lookup NU author(s): Dr Avais Jabbar, Lorna Ingoe, Dr Shahid Junejo, Dr David Austin, Professor Azfar Zaman, Dr Salman Razvi

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Abstract

Purpose: Thyroid dysfunction in patients with cardiac disease is associated with worse outcomes. This study aimed to evaluate the prevalence and analyse predictors of thyroid dysfunction in patients presenting with an acute myocardial infarction (AMI).Methods: A prospective multicentre observational study of patients recruited from six acute hospitals within the North of England. Consecutive patients without previous thyroid disease presenting with both ST-elevation AMI (STEMI) and non-ST-elevation AMI (NSTEMI) were recruited to the Thyroxine in Acute Myocardial Infarction 1 (ThyrAMI-1) cohort study between December 2014 and December 2016. Thyroid profile, standard biochemistry measurements and demographic information was obtained within 12 hours of admission to hospital. Multivariable logistic regression analyses were performed to assess the predictors of thyroid dysfunction and Cox proportional hazards analyses were utilised to compare all-cause mortality by categories of thyroid dysfunction up to June 2019.Results: Of the 1802 participants analysed, 1440 (79.9%) were euthyroid, 312 (17.3%) had subclinical hypothyroidism (SCH), 22 (1.2%) had subclinical hyperthyroidism (SHyper), 25 (1.3%) had low T3 syndrome (LT3S). Predictors for SCH were increasing age, female sex, higher thyroid peroxidase antibody (TPOAb) levels, higher serum creatinine levels, and early morning sampling time (between 00:01-06:00 hrs). The predictors of SHyper were lower body mass index and afternoon sampling time (between 12:01-18:00 hrs). Predictors of LT3S were increasing age, higher creatinine levels and presence of previous ischaemic heart disease. Compared to the euthyroid group, patients with LT3S had higher all-cause mortality; adjusted hazard ratio (95% CI) of 2.02 (1.03-3.95), p=0.04, whereas those with SCH and SHyper did not exhibit significantly increased mortality; adjusted hazard ratios (95% CI) of 1.05 (0.74-1.49), p=0.79 and 0.27 (0.04-1.95), p=0.19, respectively.Conclusions: Thyroid dysfunction is common in AMI patients on admission to hospital and our data provides an understanding regarding which factors might influence thyroid dysfunction in these patients. Furthermore, the negative association between LT3S and increased mortality post-AMI has once again been highlighted by this study. More research is required to assess if treatment of thyroid dysfunction improves clinical outcomes.


Publication metadata

Author(s): Jabbar A, Ingoe L, Thomas H, Carey P, Junejo S, Addison C, Vernazza J, Austin D, Greenwood JP, Zaman A, Razvi S

Publication type: Article

Publication status: Published

Journal: Journal of Endocrinological Investigation

Year: 2020

Pages: epub ahead of print

Online publication date: 08/09/2020

Acceptance date: 25/08/2020

Date deposited: 27/08/2020

ISSN (print): 0391-4097

ISSN (electronic): 1720-8386

Publisher: Springer

URL: https://doi.org/10.1007/s40618-020-01408-0


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