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<p>Subclinical hypothyroidism has been linked to adverse cardiovascular outcomes, but its prognostic role in acute coronary syndrome (ACS), particularly regarding sex and psychosocial factors, remains unclear. We analyzed 1584 patients with acute ACS (2017–2025) who had available thyroid-stimulating hormone (TSH) and SYNTAX scores. Patients with overt thyroid disease, thyroid therapy, or missing data were excluded. Elevated TSH was defined as &gt; 4.94 mIU/L with normal free thyroxine. Outcomes included all-cause and cardiovascular mortality and major adverse cardiovascular events. Cox regression adjusted for age, SYNTAX score, sex, psychiatric comorbidity, and social determinants. Elevated TSH levels were present in 10.5% of patients (<i>n</i> = 166). These patients were older, more frequently female, and more often widowed or unemployed. Coronary complexity did not differ by TSH status (median SYNTAX 16.0 vs. 15.0, <i>p</i> = 0.307). However, mortality was significantly higher with elevated TSH: in-hospital 9.6% versus 2.2%, 30-day 12.0% versus 4.0%, and long-term 26.5% versus 12.6% (all <i>p</i> &lt; 0.001). Elevated TSH remained independently associated with all-cause mortality (HR 1.52, 95% CI 1.04–2.22). In sex-stratified analyses, risk was nearly doubled in women (HR 1.72, 95% CI 1.09–2.71) but not in men. Psychiatric comorbidity and adverse social determinants independently predicted worse outcomes across all subgroups. Elevated admission TSH predicts adverse outcomes in ACS independent of coronary anatomy, with a pronounced effect in women. Psychiatric comorbidity and social factors further amplify risk. Incorporating endocrine and psychosocial determinants into ACS care may improve risk stratification and guide personalized interventions.</p>

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Thyroid function, coronary complexity, and socio-demographic determinants of outcomes after acute coronary syndrome: sex-specific analysis from the CaRD registry

  • 期刊论文

  • 发表日期：

    2026年3月15日

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  • Ivana Jurin,
  • Karlo Gjuras,
  • Maja Banović,
  • Tea-Terezija Cvetko,
  • Ana Matijaca,
  • Irzal Hadžibegović,
  • Kristina Marić Bešić,
  • Šime Manola,
  • Hrvoje Jurin,
  • Diana Rudan,
  • Zrinka Šakić,
  • Jozica Šikić

摘要

Subclinical hypothyroidism has been linked to adverse cardiovascular outcomes, but its prognostic role in acute coronary syndrome (ACS), particularly regarding sex and psychosocial factors, remains unclear. We analyzed 1584 patients with acute ACS (2017–2025) who had available thyroid-stimulating hormone (TSH) and SYNTAX scores. Patients with overt thyroid disease, thyroid therapy, or missing data were excluded. Elevated TSH was defined as > 4.94 mIU/L with normal free thyroxine. Outcomes included all-cause and cardiovascular mortality and major adverse cardiovascular events. Cox regression adjusted for age, SYNTAX score, sex, psychiatric comorbidity, and social determinants. Elevated TSH levels were present in 10.5% of patients (n = 166). These patients were older, more frequently female, and more often widowed or unemployed. Coronary complexity did not differ by TSH status (median SYNTAX 16.0 vs. 15.0, p = 0.307). However, mortality was significantly higher with elevated TSH: in-hospital 9.6% versus 2.2%, 30-day 12.0% versus 4.0%, and long-term 26.5% versus 12.6% (all p < 0.001). Elevated TSH remained independently associated with all-cause mortality (HR 1.52, 95% CI 1.04–2.22). In sex-stratified analyses, risk was nearly doubled in women (HR 1.72, 95% CI 1.09–2.71) but not in men. Psychiatric comorbidity and adverse social determinants independently predicted worse outcomes across all subgroups. Elevated admission TSH predicts adverse outcomes in ACS independent of coronary anatomy, with a pronounced effect in women. Psychiatric comorbidity and social factors further amplify risk. Incorporating endocrine and psychosocial determinants into ACS care may improve risk stratification and guide personalized interventions.