Influence Of Thyroid Stimulating Hormone Level On Prognosis Of Patients With Acute Coronary Syndrome

Objective:To explore the effect of thyroid stimulating hormone(TSH)on prognosis of patients with acute coronary syndrome.Methods:A total of 350 patients with Acute coronary syndrome(ACS)who were hospitalized in the Department of Cardiology,The Second Affiliated Hospital of Shanxi Medical University from January 2020 to June 2021 were enrolled.A total of 221 subjects were included in the study,including 129 patients who did not meet the inclusion criteria,including data loss,thyroid hormone use,thyroid metabolic diseases,and lost follow-up.According to thyroid stimulating hormone(TSH)level,subjects were divided into TSH normal low value group: TSH(0.38-1.85 m IU/L,n=85),TSH normal high value group:TSH(1.85-5.33 m IU/L,n=85)and TSH high value group:(TSH > 5.33 m IU/L,n=51),corresponding to group 1(85 cases),group 2(85 cases),group 3(51 cases),respectively.Baseline data,laboratory tests,cardiac color doppler ultrasound indicators,coronary artery lesions,nosocomial medication and adverse events,out-of-hospital medication,Major adverse cardiovascular events(MACE)and the occurrence of endpoint events were collected and observed in the three groups.The effects of the three groups on nosocomial adverse cardiovascular events,out-of-hospital adverse cardiovascular events and endpoint events in ACS patients were analyzed.Results:1.Comparison of baseline data of the three groups: there were differences in WBC,TC,TG,FT4 and c Tn I levels among the three groups,with P<0.05 as difference.Further comparison between the two groups showed that(α adjusted to 0.0167):(1)The WBC level of group 1 was significantly higher than that of group 2 and group 3(P=0.015);(2)The TC level in group 1 was significantly lower than that in groups 2 and3(P=0.010);(3)There were no significant differences in TG,FT4 and c Tn I levels in pairwise comparison.2.Comparison of adverse events in hospital: There was statistical difference in the incidence of arrhythmia among the three groups.The incidence of arrhythmia in group 3was the highest,followed by group 1(5.9% in group 1,2.4% in Group 2,17.6% in group3,P=0.005).After adjusting for age and sex,the risk of arrhythmia was still higher in group 3(OR 3.636 95%CI 1.116-11.846 P=0.009).After further adjustment for multiple factors,group 3 was still a risk factor for arrhythmia events,and the difference was statistically significant(OR 5.004 95%CI 1.231 ～ 20.345 P=0.024).There was no significant difference in the incidence of arrhythmia between the two groups(P=0.314).3.Comparison of out-of-hospital adverse events:the incidence of MACE composite endpoint events was statistically different among the three groups(P=0.028).The univariate COX risk regression showed that: GFR< 45 m L /min(P=0.009),TG >1.69mmol/L(P=0.004),TC > 5.70mmol/L(P=0.024),TSH > 5.33 MIU /L(P=0.010)were associated with increased risk of MACE events.TC > 5.70mmol/L increased the incidence of MACE was low(P=0.024).When P < 0.05 was included in multivariate COX regression,TSH > 5.33 m IU/L(P=0.036)was still associated with an increased risk of MACE,but TSH > 5.33 m IU/L had a lower risk of MACE(P=0.036).TSH(1.73-5.33 m IU/L)also increased the risk of MACE,but the difference was not statistically significant(HR 1.112,P=0.834).4.Multivariate COX risk analysis of endpoint events: There was no significant difference in the incidence of all-cause death and cardiogenic death in groups 3 and 2,but the risk of all-cause death increased with the decrease of GFR level(HR 2.072,P=0.013),in addition to LVEF < 50%(HR 3.593,P=0.007).LVEF < 50% was also a risk factor for cardiac death(HR 4.801,P=0.047).Conclusion:1.TSH elevation beyond the normal range can increase the risk of nosocomial arrhythmia events in ACS patients.2.TSH is associated with the risk of out-of-hospital MACE composite events in PATIENTS with ACS,and the increase of TSH beyond the normal range can increase the risk of MACE composite end point events in patients with ACS.3.TSH normal group had no significant effect on the occurrence of ACS patients’ adverse events in and out of hospital.4.TSH > 5.33 m IU/L can be used as an independent risk factor for the prognosis of ACS patients.