ABC | Volume 110, Nº2, February 2018

Original Article Is There Any Relationship between TSH Levels and Prognosis in Acute Coronary Syndrome? Alexandre de Matos Soeiro, 1 Victor Arrais Araújo, 1 Júlia Pitombo Vella, 1 Aline Siqueira Bossa, 1 Bruno Biselli, 1 Tatiana de Carvalho Andreucci Torres Leal, 1 Maria Carolina Feres de Almeida Soeiro, 1 Carlos V. Serrano Jr., 1 Christian Mueller, 2 Mucio Tavares de Oliveira Junior 1 Unidade Clínica de Emergência - InCor – HCFMUSP, 1 São Paulo, SP; Universidade de Basel, 2 Basel, Suíça Mailing Address: Alexandre de Matos Soeiro • Rua João Moura, 870, apto 192b. CEP 05412-002, Pinheiros, São Paulo, SP – Brazil E-mail: alexandre.soeiro@bol.com.br Manuscript received April 09, 2017, revised manuscript July 26, 2017, accepted August 29, 2017 DOI: 10.5935/abc.20180019 Abstract Background: Some small studies have related higher levels of thyrotropin (TSH) to potentially worse prognosis in acute coronary syndromes. However, this relationship remains uncertain. Objective: To analyze the outcomes of patients with acute coronary syndromes in relation to the value of TSH at admission. Methods: Observational and retrospective study with 505 patients (446 in group I [TSH≤ 4mIU/L] and 59 in group II [TSH > 4 mIU/L]) with acute coronary syndromes between May 2010 and May 2014. We obtained data about comorbidities and the medications used at the hospital. The primary endpoint was in-hospital all-cause death. The secondary endpoint included combined events (death, non-fatal unstable angina or myocardial infarction, cardiogenic shock, bleeding and stroke). Comparisons between groups were made by one-way ANOVA and chi-square test. Multivariate analysis was determined by logistic regression. Analyses were considered significant when p < 0.05. Results: Significant differences between groups I and II were observed regarding the use of enoxaparin (75.2% vs. 57.63%, p = 0.02) and statins (84.08% vs. 71.19%, p < 0.0001), previous stroke (5.83% vs. 15.25%, p = 0.007), combined events (14.80% vs. 27.12%, OR = 3.05, p = 0.004), cardiogenic shock (4.77% vs. 6.05%, OR = 4.77, p = 0.02) and bleeding (12.09% vs. 15.25%, OR = 3.36, p = 0.012). Conclusions: In patients with acute coronary syndromes and TSH > 4 mIU/L at admission, worse prognosis was observed, with higher incidences of in-hospital combined events, cardiogenic shock and bleeding. (Arq Bras Cardiol. 2018; 110(2):113-118) Keywords: Acute Coronary Syndrome; Thyrotropin/metabolism; Euthyroid Sick Syndromes; Hospital Mortality. Introduction Patients with severe nonthyroidal illness often experience concomitant disorders in thyroid function. In severe illness of nonthyroidal origin, including acute myocardial infarction (AMI), the thyroid hormone system may be down-regulated. These conditions can induce changes in one or more aspects of thyroid hormone economy, leading to findings referred to as sick euthyroid syndrome, which poses a diagnostic and therapeutic challenge for the clinician. The cardiovascular system is very sensitive to thyroid hormones, and a wide spectrum of cardiac changes has long been recognized in overt thyroid dysfunction. 1-3 The real value of thyrotropin (TSH) as marker of prognosis in acute coronary syndromes (ACS) is still uncertain. Therefore, the objective of this study was to analyze the outcomes of patients with ACS related with the TSH value measured in the emergency department. Methods Study population This was an observational, retrospective databank analysis study performed in a tertiary health centre with 505 patients with ACS included between May 2010 and May 2014. They were divided in two groups: TSH ≤ 4 mIU/L (group I, n = 446) and TSH > 4 mIU/L (group II, n = 59). Patients with known thyroid disorders were excluded. All patients were diagnosed and treated according to the AHA/ESC Task Force guidelines. 4,5 All patients underwent percutaneous coronary intervention less than 24 hours after onset of ACS. The primary outcome was in-hospital all-cause mortality. The secondary outcome was major adverse cardiac events (MACE) including death (of any cause), non-fatal unstable angina or AMI/target vessel revascularization, cardiogenic shock, bleeding (major and minor), and stroke. The studywas approved by the ethics and research committee. 113