Key result
A combination of low fT3/fT4 ratio (<0.206) and high NT-pro-BNP (≥290.4 ng/L) significantly increased the risk of all-cause mortality (HR 2.03) in patients with coronary artery disease after acute coronary syndrome.
Cohort (n=642)
No
Hazard Ratio: 2.03 (95% CI 1.39–2.96)
p-value: p=<0.001
Thyroid hormones (fT4 and fT3/fT4 ratio) combined with NT-pro-BNP levels serve as independent prognostic markers for long-term all-cause and cardiac mortality in patients undergoing cardiac rehabilitation after an acute coronary syndrome.
These markers may refine post-ACS mortality prediction during rehabilitation; leaves open prospective validation and impact on management.
BACKGROUND: Altered thyroid function and increased rates of N-terminal pro-B-Type natriuretic peptide (NT-pro-BNP) are highly prevalent in coronary artery disease (CAD) patients with heart failure, and are associated with unfavorable prognosis. This study was undertaken to examine the relationship and prognostic impact of thyroid hormones, inflammatory biomarkers, and NT-pro-BNP on long-term outcomes in patients after acute coronary syndrome (ACS). METHODS: The study comprised of 642 patients (age 58 ± 10 years, 77% male) attending an in-patient cardiac rehabilitation program after experiencing ACS. Patients were evaluated for demographic, clinical and CAD risk factors as well as thyroid hormones (e.g., fT3, fT4 level, fT3/fT4 ratio), inflammatory biomarkers (hs-CRP, IL-6) and NT-pro-BNP levels. Data on fT3/fT4 ratio and NT-pro-BNP levels were not normally distributed and were natural-log transformed (ln). Both all-cause (cumulative) and cardiac-related mortality were considered the primary outcomes of interest. RESULTS: According to the Cox model, age, NYHA class, (ln)NT-pro-BNP levels (HR 1.53, 95% CI 1.13-2.07), fT4 level (HR 1.15, 95% CI 1.04-1.27), and (ln)fT3/fT4 ratio (HR 0.08, 95% CI 0.02-0.32) were the most important predictors of all-cause mortality among CAD patients after ACS. Similarly, age, NYHA class, (ln)NT-pro-BNP levels (HR 1.62, 95% CI 1.11-2.36), fT4 (HR 1.15, 95% CI 1.02-1.29) and (ln)fT3/fT4 ratio (HR 0.10, 95% CI 0.02-0.55) independently predicted cardiac-related mortality. Kaplan-Meier analyses provided significant prognostic information with the highest risk for all-cause mortality in the low cut off measures of fT3/fT4 ratio <0.206 and NT-pro-BNP ≥ 290.4 ng/L (HR 2.03, 95% CI 1.39-2.96) and fT4 level >12.54 pg/ml (HR = 2.34, 95% CI 1.05-5.18). There was no association between hs-CRP, IL-6 and mortality in CAD patients after ACS. CONCLUSIONS: Thyroid hormones (i.e., fT4 level and fT3/fT4 ratio) together with NT-pro-BNP level may be valuable and simple predictors of long-term outcomes of CAD patients after experiencing ACS.
No takes yet. Share an insight, caveat, or question.
Brožaitienė et al. (2016) conducted a cohort in Coronary artery disease after acute coronary syndrome (n=642). Low fT3/fT4 ratio (<0.206) and high NT-pro-BNP (≥290.4 ng/L) vs. Other groups was evaluated on All-cause mortality (HR 2.03, 95% CI 1.39-2.96, p=<0.001). A combination of low fT3/fT4 ratio (<0.206) and high NT-pro-BNP (≥290.4 ng/L) significantly increased the risk of all-cause mortality (HR 2.03) in patients with coronary artery disease after acute coronary syndrome.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: