ABC | Volume 110, Nº2, February 2018

Original Article Soeiro et al TSH versus SCA Arq Bras Cardiol. 2018; 110(2):113-118 1. Satar S, Seydaoglu G, Avci A, Sebe A, KarciogluO, Topal M. Prognostic value of thyroid hormone levels in acute myocardial infarction: just an epiphenomenon? Am Heart Hosp J. 2005;3(4):227-33. doi: 10.1111/j.1541-9215.2005.04653.x. 2. Stamate CS, Andronescu AM, Nechita AC, Delcea C, Mihu EM, Vintila MM. Physiopathological aspects of the subclinical alterations of thyroid function associated with acute coronary syndromes. J Med Life. 2013;6(4):409-13. PMID: 24868251. 3. Klein I, Danzi S. Thyroid disease and the heart. Circulation. 2007;116(15):1725-35.doi:10.1161/CIRCULATIONAHA.106.678326. Erratum in: Circulation. 2008;117(3):e18. 4. Hamm CW, Bassand J, Agewall S, Bax J, Boersma E, Bueno H, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). European Heart J. 2011;32(23):2999-3054. doi: 10.1093/eurheartj/ehr236. 5. Jneid H, Anderson JL, Wright RS, Adams CD, Bridges CR, Casey DE, et al; American College of Cardiology Foundation; American Heart Association Task Force on Practice Guidelines. 2012 ACCF/AHA FocusedUpdate of the Guideline for theManagement of PatientsWith Unstable Angina/Non ST-Elevation Myocardial Infarction (Updating the 2007 Guideline and Replacing the 2011 Focused Update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2012;126(7):875-910. doi: 10.1161/CIR.0b013e318256f1e0. 6. Mehran R, Rao SV, Bahht DL, Gibson M, Caixeta A, Eikelboom J, et al. Standardized bleeding definitions for cardiovascular clinical trials. a consensus report from the Bleeding Academic Research Consortium. Circulation. 2011;123(23):2736-47. doi: 10.1161/ CIRCULATIONAHA.110.009449. 7. Parle JV, Maisonneuve P, SheppardMC, Boyle P, Franklyn JA. Prediction of all-cause and cardiovascular mortality in elderly people from one low serum thyrotropin result: a 10-year cohort study. Lancet. 2001;358(9285):861-5. doi: 10.1016/S0140-6736(01)06067-6. 8. Cappola AR, Fried LP, Arnold AM, Danese MD, Kuller LH, Burke GL, et al. Thyroid status, cardiovascular risk, and mortality in older adults. JAMA. 2006;295(9):1033-41. doi: 10.1001/jama.295.9.1033. 9. Christ-Crain M, Meier C, Guglielmetti M, Huber PR, Riesen W, Staub JJ, et al. Elevated C-reactive protein and homocysteine values: cardiovascular risk factors in hypothyroidism? A cross-sectional and a double-blind placebo-controlled trial. Atherosclerosis. 2003;166(2):379-86. doi: 10.1016/S0021-9150(02)00372-6. 10. Rodondi N, Aujesky D, Vittinghoff E, Cornuz J, Bauer DC. Subclinical hypothyroidismand the risk of coronary heart disease: ameta-analysis. AmJMed. 2006;119(7):541-51. doi: 10.1016/j.amjmed.2005.09.028. 11. Abdulaziz Qari F. Thyroid hormone profile in patients with acute coronary syndrome. Iran Red Crescent Med J. 2015;17(7):e26919. doi: 10.5812/ircmj.26919v2. 12. KleinI,OjamaaK.Thyroidhormoneandthecardiovascularsystem.NEngl J Med. 2001;344(7):501-9. doi: 10.1056/NEJM200102153440707. References In summary, different studies have shown a relationship between prognosis and the level of thyroid hormones in ACS. However, the best cut-off, the ideal moment to evaluate TSH levels, and the expected changes after ACS are not known. Combining our results with others from the literature, we postulate that the value of TSH on hospital admission could be helpful and that the prognosis is worse if TSH levels are high at that timepoint. In addition, including the evaluation of other thyroid hormones could be beneficial. Limitations This study showed some limitations, such as the small number of patients evaluated. In addition, we did not measure other thyroid hormones. In addition, this is a retrospective study, and the group with higher TSH levels had worse baseline characteristics, such as higher troponin levels and lower ejection fraction. However, this is an original and novel observation, and other prospective studies will be required. Conclusion In patients with ACS and TSH > 4 mIU/L on hospital admission, worse prognosis was observed, with higher incidences of in-hospital MACE, cardiogenic shock and bleeding events. Author contributions Conception and design of the research: Soeiro AM, Araújo VA, Vella JP, Oliveira Junior MT; Acquisition of data: Soeiro AM, Araújo VA, Vella JP, Bossa AS, Biselli B, Leal TCAT, Soeiro MCFA; Analysis and interpretation of the data: Soeiro AM; Análise estatística: Soeiro AM, Bossa AS; Writing of the manuscript: Soeiro AM, Araújo VA, Vella JP; Critical revision of the manuscript for intellectual content: Soeiro AM, Soeiro MCFA, Serrano Jr. CV, Mueller C, Oliveira Junior MT. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associatedwith any thesis or dissertationwork. Ethics approval and consent to participate This study was approved by the Ethics Committee of the CAPPesq under the protocol number 38511114700000068. All the procedures in this study were in accordance with the 1975 Helsinki Declaration, updated in 2013. Informed consent was obtained from all participants included in the study. 117