The Association between Thyroid-Stimulating Hormone and Long-Term Outcomes in Patients with ST Segment Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention

Figures & data

Table 1 Baseline Characteristics of the Study Population

	Group 1 (n = 132)	Group 2 (n = 497)	Group 3 (n = 491)	Group 4 (n = 66)	P value
	(TSH <0.35 mIU/L)	(TSH 0.35–1.0 mIU/L)	(TSH 1.0–3.5 mIU/L)	(TSH >3.5 mIU/L)
Demographics
Age, years	61.57 ± 12.16	63.12 ± 12.04	63.83 ± 12.51	69.03 ± 13.32	0.001
Male, %	106 (80.3)	404 (81.3)	389 (79.2)	44 (66.7)	0.052
BMI, kg/m^2	23.31 ± 4.67	23.89 ± 3.81	24.22 ± 4.14	24.05 ± 3.73	0.132
Smoker, %	94 (71.2)	348 (70.0)	321 (65.5)	38 (57.6)	0.106
Medical history, %
Hypertension	59 (44.7)	242 (48.7)	271 (55.2)	43 (65.2)	0.009
Diabetes mellitus	25 (18.9)	100 (20.1)	113 (23.0)	20 (30.3)	0.195
Dyslipidemia	13 (9.8)	50 (10.1)	59 (12.0)	5 (7.6)	0.601
Previous MI	8 (6.1)	23 (4.6)	17 (3.5)	0 (0)	0.145
Previous stroke	4 (3.0)	28 (5.6)	38 (7.7)	6 (9.1)	0.139
Renal insufficiency	2 (1.5)	16 (3.2)	9 (1.8)	8 (12.1)	0.001
Clinical presentation
SBP, mmHg	119.73 ± 26.22	121.42 ± 23.60	128.78 ± 25.50	133.08 ± 30.05	<0.001
DBP, mmHg	74.25 ± 15.86	75.10 ± 15.44	78.93 ± 15.75	82.45 ± 20.28	<0.001
Heart rate, bpm	81.31 ± 21.62	82.92 ± 18.84	81.77 ± 16.64	86.55 ± 19.21	0.187
Killip class >I, %	46 (34.8)	136 (27.4)	109 (22.2)	21 (31.8)	0.014
Cardiac arrest, %	9 (6.8)	37 (7.4)	14 (2.9)	4 (6.1)	0.007
Cardiogenic shock, %	19 (14.4)	46 (9.3)	29 (5.9)	4 (6.1)	0.011

Abbreviations: BMI, body mass index; MI, myocardial infarction; SBP, systolic blood pressure; DBP, diastolic blood pressure.

Table 2 Electrocardiogram and Coronary Features of the Study Population

	Group 1 (n = 132)	Group 2 (n = 497)	Group 3 (n = 491)	Group 4 (n = 66)	P value
	(TSH <0.35 mIU/L)	(TSH 0.35–1.0 mIU/L)	(TSH 1.0–3.5 mIU/L)	(TSH >3.5 mIU/L)
Location of MI, %
Anterior MI	62 (47.0)	257 (51.7)	280 (57.0)	39 (59.1)	0.104
Inferior MI	74 (56.1)	261 (52.5)	226 (46.0)	30 (45.5)	0.077
Culprit vessel, %					0.057
LM	2 (1.5)	2 (0.4)	1 (0.2)	1 (1.5)
LAD	59 (44.7)	238 (47.9)	266 (54.2)	34 (51.5)
LCX	18 (13.6)	44 (8.9)	55 (11.2)	4 (6.1)
RCA	53 (40.2)	213 (42.9)	169 (34.4)	27 (40.9)
Triple-vessel disease, %	24 (18.2)	87 (17.5)	79 (16.1)	16 (24.2)	0.423
Post-TIMI < III, %	6 (4.5)	26 (5.2)	20 (4.1)	8 (12.1)	0.046
Thrombus aspiration, %	8 (6.5)	43 (8.7)	33 (6.7)	4 (6.1)	0.675
GP IIb/IIIa inhibitors, %	60 (48.8)	231 (46.5)	200 (40.7)	23 (34.8)	0.082
Stenting, %	114 (86.4)	431 (86.7)	425 (86.6)	51 (77.3)	0.209

Abbreviations: MI, myocardial infarction; LM, left main artery; LAD, left anterior descending artery; LCX, left circumflex artery; RCA, right coronary artery; TIMI, thrombolysis in myocardial infarction flow grade.

Table 3 Laboratory Findings of the Study Population

	Group 1 (n = 132)	Group 2 (n = 497)	Group 3 (n = 491)	Group 4 (n = 66)	P value
	(TSH <0.35 mIU/L)	(TSH 0.35–1.0 mIU/L)	(TSH 1.0–3.5 mIU/L)	(TSH >3.5 mIU/L)
Laboratory findings
Troponin I, ng/mL	10.97 ± 11.98	10.56 ± 11.48	9.51 ± 10.74	7.26 ± 9.34	0.084
BNP >100pg/mL, %	53/98 (54.1)	163/370 (44.1)	195/351 (55.6)	29/44 (65.9)	0.002
WBC, ×10^9/L	12.48 ± 3.89	11.84 ± 4.07	10.96 ± 3.76	10.57 ± 3.82	<0.001
Hemoglobin, g/L	140.23 ± 18.85	138.72 ± 19.08	137.34 ± 20.15	134.15 ± 18.26	0.138
Creatinine, μmol/L	89.80 ± 86.50	83.28 ± 38.11	84.16 ± 58.87	93.67 ± 63.19	0.367
TC, mmol/L	4.38 ± 0.92	4.38 ± 1.11	4.51 ± 1.10	4.60 ± 0.95	0.135
LDL-C, mmol/L	2.81 ± 0.88	2.82 ± 0.97	2.90 ± 0.94	3.06 ± 0.84	0.168
HDL-C, mmol/L	1.11 ± 0.31	1.12 ± 0.33	1.10 ± 0.31	1.13 ± 0.30	0.683
TSH, uIU/mL	0.24 ± 0.09	0.66 ± 0.19	1.70 ± 0.57	6.80 ± 5.37	<0.001
FT3, pg/mL	3.16 ± 1.80	2.85 ± 0.48	2.90 ± 0.47	2.83 ± 0.46	<0.001
FT4, ng/dL	1.01 ± 0.58	0.91 ± 0.18	0.91 ± 0.18	0.84 ± 0.19	<0.001
LVEF, %	54.54 ± 7.78	55.20 ± 7.47	55.24 ± 7.12	55.50 ± 8.24	0.786
LVEF <50%, %	25/125 (20.0)	87/458 (19.0)	76/446 (17.0)	12/62 (19.4)	0.828
LVEDD, mm	48.97 ± 5.09	49.06 ± 5.34	49.23 ± 5.61	49.03 ± 5.83	0.949

Abbreviations: BNP, brain natriuretic peptide; WBC, white blood cell; TC, total cholesterol; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; TSH, thyroid-stimulating hormone; FT3, free triiodothyronine; FT4, free thyroxine; LVEF, left ventricular ejection fraction; LVEDD, left ventricular end-diastolic dimension.

Table 4 Medications During Hospitalization and After Discharge of All Groups

	Group 1 (n = 132)	Group 1 (n = 497)	Group 2 (n = 491)	Group 3 (n = 66)	P value
	(TSH <0.35 mIU/L)	(TSH 0.35–1.0 mIU/L)	(TSH 1.0–3.5 mIU/L)	(TSH >3.5 mIU/L)
Medications during hospitalization, %
Aspirin	125 (94.7)	477 (96.0)	475 (96.7)	60 (90.0)	0.138
Clopidogrel	38 (40.3)	148 (29.8)	152 (31.0)	24 (36.4)	0.700
Ticagrelor	97 (73.5)	354 (71.2)	345 (70.3)	42 (63.6)	0.536
Statins	128 (97.0)	493 (99.2)	487 (99.2)	64 (97.0)	0.054
ACEI/ARB	54 (40.9)	175 (35.2)	206 (42.0)	29 (43.9)	0.130
β-Blocker	77 (58.3)	263 (52.9)	292 (59.5)	42 (63.6)	0.119
PPI	111 (84.1)	415 (83.5)	393 (80.0)	55 (83.3)	0.478
Medications after discharge, %
Aspirin	115/129 (89.1)	416/469 (88.7)	419/471 (89.0)	52/63 (82.5)	0.505
Clopidogrel	48 (37.2)	192 (40.9)	196 (41.6)	34 (54.0)	0.167
Ticagrelor	79 (61.2)	278 (59.3)	270 (57.3)	28 (44.4)	0.128
Statins	127 (98.4)	465 (99.1)	464 (98.5)	62 (98.4)	0.693
ACEI/ARB	86 (66.7)	298 (63.5)	321 (68.2)	44 (69.8)	0.446
β-Blocker	100 (77.5)	385 (82.1)	374 (79.4)	54 (85.7)	0.403
PPI	94 (72.9)	348 (74.2)	337 (71.5)	39 (61.9)	0.222

Abbreviations: ACEI, angiotensin-converting enzyme inhibitors; ARB, angiotensin receptor blockers; PPI, proton pump inhibitors.

Figure 1 The major adverse events during hospitalization and long-term all-cause mortality of the four groups.

Figure 2 (A) The cumulative survival in Group 4 was remarkably lower (Log rank P < 0.001), whereas the cumulative survival was comparable in the other three groups (Log rank P = 0.365). (B) When patients were divided into two groups, the cumulative survival of patients with TSH >3.5 mIU/L was significantly lower than that of TSH ≤ 3.5 mIU/L (Log rank P < 0.001).

Table 5 Multivariate Cox Proportional Hazard Models of TSH in Different Levels for All-Cause Mortality in STEMI

TSH, mIU/L	Unadjusted		Model 1		Model 2		Model 3		Model 4
	HR (95% CI)	P value	HR (95% CI)	P value	HR (95% CI)	P value	HR (95% CI)	P value	HR (95% CI)	P value
<0.35	1.45 (0.74–2.85)	0.283	0.76 (0.39–1.50)	0.432	0.79 (0.40–1.56)	0.499	0.63 (0.32–1.24)	0.182	0.55 (0.24–1.23)	0.145
0.35–1.0	1.00 (Ref.)		1.00 (Ref.)		1.00 (Ref.)		1.00 (Ref.)		1.00 (Ref.)
1.0–3.5	1.13 (0.77–1.64)	0.537	1.07 (0.73–1.56)	0.725	1.04 (0.70–1.52)	0.859	1.24 (0.84–1.83)	0.278	0.85 (0.53–1.35)	0.489
>3.5	3.03 (1.81–5.08)	<0.001	2.25 (1.33–3.80)	0.002	2.29 (1.36–3.89)	0.002	2.67 (1.57–4.55)	<0.001	2.06 (1.09–3.90)	0.027

Notes: Model 1: Adjusted for age and sex. Model 2: Model 1 + BMI, hypertension, diabetes, dyslipidemia, previous MI and previous stroke. Model 3: Model 2 + systolic blood pressure, heart rate, cardiac arrest and cardiogenic shock. Model 4: Model 3 + troponin I, LDL-C, creatinine and BNP >100pg/mL.

Abbreviations: BMI, body mass index; MI, myocardial infarction; LDL-C, low-density lipoprotein cholesterol; BNP, brain natriuretic peptide.