Impact Of Subclinical Hypothyroidism On Prognosis After Percutaneous Coronary Intervention For Chronic Total Occlusion

Objective To examine the influence of subclinical hypothyroidism on the prognosis of patients with coronary chronic total occlusion after Interventi-onal therapy.Methods 120 patients with CTO lesion diagnosed in our Hospital from August 2018 to October 2019 were selected in this study.On the basis of the level of TSH,we divided the patients into two groups: normal thyroid function group(n =98)and SCH group(n=22).Compare clinical traits and angiographic findings of the two sets,then multivariate Cox survival analysis was used to compare the difference of MACCE between the two sets during follow-up,and multivariate Cox regression analysisw as used to judge the independent relationship between SCH and adversecl inical outcomes.Results The median TSH level was 2.31 m IU/L,and the mean FT4 level was 1.15±0.19 pmol/L in patients with CTO.Among them,22 cases were diagnosed with(SCH,accounting for 18.3%.Compared with the ET group,the(SCH group was older(62.39±9.83 vs 67.73 ± 9.57,0.022),and the proportion of diabetes was lower(40.8% vs 13.6% P=0.005),e GFR was slightly lower(95.17±18.55vs86.14±18.65).The proportion of target lesions of LAD was higher(32.7% vs 59.1% P=0.021).No difference existed in other indexes between the two groups(P>0.05).18 months were the average follow-up period,and 10 cases happened MACCE during the follow-up.Kaplan-Meire survival curve suggested that there were obvious differenc es in MACCE-free cumulative survival rate and that about stroke-free in the two setgroups.During the follow-up,MACCE appeared(22.7% vs 5.1%,P=0.008)and stroke appeared(9.1% vs 1.0%,P=0.029)in the SCH group were obviously higher than those in the normal group,and the diffe rence was statistically significant.The happening of cardiogenic death(4.5% vs 2.0%,P=0.475),non-fatal myocardial infarction(4.5% vs 1.0% scor e 0.230)and revascularization of the original culprit vessels(4.5% vs 1.0% score 0.233)were higher than those in the ET group,but the differe nce was not statistically significant.Univariate analysis showed that SCH was independently correlated with MACCE(HR=4.621,95%CI:1.336~15.989,P=0.016).Multivariate Cox regression analysis showed that SCH could still increase the risk of postoperative MACCE(HR=4.559,95%CI:1.318~15.770,P=0.017),including age,hypertension,LVEF <50% and SYNTAX score.Conclusion The prognosis of CTO-PCI patients with SCH is poor,and the risk of MACCE is significantly elevated.Thyroid function should be teste d in CTO patients treated with PCI,and the recurrence of cardio-cerebro vascular events after PCI should be closely observed in SCH patients.