Thyroid hormones help predict cardiogenic shock risk in STEMI patients post-PCI

Free triiodothyronine (FT3) and free thyroxine (FT4) independently predict in-hospital cardiogenic shock (CS) incidence among patients with ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI), reports a recent study.

The study included 1,270 STEMI patients (mean age 63.5 years, 79.6 percent men), of whom 103 developed CS while hospitalized. Thyroid hormone levels, including FT3, FT4, and high-sensitivity thyroid-stimulating hormone (hsTSH), were obtained from medical records.

Patients who developed CS tended to be older and smokers, were more likely female, and more often had heart failure. Haemoglobin, FT3, and hsTSH levels were lower in CS patients, while concentrations FT4, creatinine, and high-sensitivity C-reactive protein were elevated.

Multivariate logistic analysis revealed that FT3 was a significant and inverse correlate of CS, such that each 1-pg/mL increase in FT3 cut the likelihood of such by 40 percent (odds ratio [OR], 0.60, 95 percent confidence interval [CI], 0.37–0.97; p=0.038). Meanwhile, FT4 emerged as a strong risk factor, more than doubling the likelihood of CS with each 1-ng/dL increase in FT4 (OR, 2.44, 95 percent CI, 1.12–5.30; p=0.024).

Restricted cubic spline analysis further suggested that when FT3 dropped below 2.25 pg/mL or when FT4 rose beyond 1.25 ng/dL, the risk of CS would increase sharply.

“Assessment of thyroid hormones may facilitate the risk stratification of either in-hospital outcomes or long-term mortality in STEMI patients treated with PCI,” the researchers said.