Evolutionary and prognostic implications in patient with acute coronary syndrome and dysthyroidism

Purpose. The study aims to determine the impact of dysthyroidism on the severity and type of coronary lesion, on vascular function, as well as on the morbidity and mortality of patients with acute coronary syndrome, by finding predictive markers that can be translated into preventive measures that c...

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Main Authors: Eleonora DRĂGAN, Maria Suzana GUBERNA, Cătălina Liliana ANDREI, Crina-Julieta SINESCU
Format: Article
Language:English
Published: Amaltea Medical Publishing House 2021-06-01
Series:Romanian Journal of Medical Practice
Subjects:
Online Access:https://rjmp.com.ro/articles/2021.2/RJMP_2021_2_Art-20.pdf
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language English
format Article
sources DOAJ
author Eleonora DRĂGAN
Maria Suzana GUBERNA
Cătălina Liliana ANDREI
Crina-Julieta SINESCU
spellingShingle Eleonora DRĂGAN
Maria Suzana GUBERNA
Cătălina Liliana ANDREI
Crina-Julieta SINESCU
Evolutionary and prognostic implications in patient with acute coronary syndrome and dysthyroidism
Romanian Journal of Medical Practice
acute coronary syndrome
thyroid dysfunction
syntax score
outcome
author_facet Eleonora DRĂGAN
Maria Suzana GUBERNA
Cătălina Liliana ANDREI
Crina-Julieta SINESCU
author_sort Eleonora DRĂGAN
title Evolutionary and prognostic implications in patient with acute coronary syndrome and dysthyroidism
title_short Evolutionary and prognostic implications in patient with acute coronary syndrome and dysthyroidism
title_full Evolutionary and prognostic implications in patient with acute coronary syndrome and dysthyroidism
title_fullStr Evolutionary and prognostic implications in patient with acute coronary syndrome and dysthyroidism
title_full_unstemmed Evolutionary and prognostic implications in patient with acute coronary syndrome and dysthyroidism
title_sort evolutionary and prognostic implications in patient with acute coronary syndrome and dysthyroidism
publisher Amaltea Medical Publishing House
series Romanian Journal of Medical Practice
issn 1842-8258
2069-6108
publishDate 2021-06-01
description Purpose. The study aims to determine the impact of dysthyroidism on the severity and type of coronary lesion, on vascular function, as well as on the morbidity and mortality of patients with acute coronary syndrome, by finding predictive markers that can be translated into preventive measures that contribute substantially to reduce the number of newly diagnosed patients with coronary heart disease. Methods. We introduced in the study 100 patients recently diagnosed with acute coronary syndrome, without history of ischemic heart disease or thyroid disease, hospitalized in the Cardiology Clinic of the “Bagdasar-Arseni“ Emergency Clinical Hospital Bucharest, for the interventional treatment of acute coronary syndrome. The studied patients were hospitalized between November 2014 and April 2015, with regular follow-up of up to 5 years (telephone or direct interview, conducted at 6 months, 12 months, 24 months, 36 months, 48 months, 60 months), with an average period follow-up of 1006 days, evaluated clinically, bio-humorally, by echocardiography, explored with coronary angiography with the calculation of the SYNTAX score and with the performance of electrocardiogram and pulse wave. The obtained data were integrated in Excel sheets and statistically processed with the Python program. Results. The mortality rate in the patient group was 7% (7 deaths). Descriptively, of the deceased, 6 patients (86%) were male, and as thyroid status 1 hyperthyroid patient (14%), 3 hypothyroid patients (43%) and 3 patients (43%) normothyroid. There were 4 deaths (8%) in the group of patients with unstable angina and 3 deaths (8%) in the group of patients with myocardial infarction without ST-segment elevation. There were no deaths in the group of patients with acute myocardial infarction with ST-segment elevation. At follow-up, 41 patients (41%) were readmitted. Re-hospitalization was influenced by elevated values of mean blood pressure, diastolic blood pressure and C-reactive protein, unicoronary atherosclerotic disease and unstable angina at admission. At follow-up, the development of noncardiac events was noted in the evolution of patients, diabetes mellitus occurring in the majority, in almost a quarter of patients (22 patients, respectively 24% developed diabetes over time), 34% (19 patients) in euthyroidism and 8% (3 patients) dysthyroidism. Discussions. Predictive factors for the readmission of the patient with acute coronary syndrome are highlighted the following: increased level of C-reactive protein (p = 0.017), tricoronary vascular damage (p = 0.01), diastolic blood pressure greater than 80 mmHg (p = 0.025), and euthyroid status (p = 0.04). The probability of death for the patient with acute coronary syndrome rises to 66% in the presence of severe systolic dysfunction of the left ventricle (p = 0.006), and to 61% in the case of elevated values of hs troponin I (p = 0.008). In our study, the presence of dysthyroidism in the patient with acute coronary syndrome has a protective role in the development of diabetes in the first 5 years (p = 0.025). Conclusion. Dysthyroidism is associated with increased morbidity and mortality from cardiovascular disease.
topic acute coronary syndrome
thyroid dysfunction
syntax score
outcome
url https://rjmp.com.ro/articles/2021.2/RJMP_2021_2_Art-20.pdf
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spelling doaj-a80bbfa7d43743ba92a1ee5d07a5d2242021-09-02T22:00:37ZengAmaltea Medical Publishing HouseRomanian Journal of Medical Practice1842-82582069-61082021-06-0116222523310.37897/RJMP.2021.2.20Evolutionary and prognostic implications in patient with acute coronary syndrome and dysthyroidismEleonora DRĂGAN0Maria Suzana GUBERNA1Cătălina Liliana ANDREI2Crina-Julieta SINESCU3Universitatea de Medicină și Farmacie „Carol Davila“, București, România; Clinica de Cardiologie, Spitalul Clinic de Urgență „Bagdasar-Arseni“, București, RomâniaUniversitatea de Medicină și Farmacie „Carol Davila“, București, România; Clinica de Cardiologie, Spitalul Clinic de Urgență „Bagdasar-Arseni“, București, RomâniaUniversitatea de Medicină și Farmacie „Carol Davila“, București, România; Clinica de Cardiologie, Spitalul Clinic de Urgență „Bagdasar-Arseni“, București, RomâniaUniversitatea de Medicină și Farmacie „Carol Davila“, București, România; Clinica de Cardiologie, Spitalul Clinic de Urgență „Bagdasar-Arseni“, București, RomâniaPurpose. The study aims to determine the impact of dysthyroidism on the severity and type of coronary lesion, on vascular function, as well as on the morbidity and mortality of patients with acute coronary syndrome, by finding predictive markers that can be translated into preventive measures that contribute substantially to reduce the number of newly diagnosed patients with coronary heart disease. Methods. We introduced in the study 100 patients recently diagnosed with acute coronary syndrome, without history of ischemic heart disease or thyroid disease, hospitalized in the Cardiology Clinic of the “Bagdasar-Arseni“ Emergency Clinical Hospital Bucharest, for the interventional treatment of acute coronary syndrome. The studied patients were hospitalized between November 2014 and April 2015, with regular follow-up of up to 5 years (telephone or direct interview, conducted at 6 months, 12 months, 24 months, 36 months, 48 months, 60 months), with an average period follow-up of 1006 days, evaluated clinically, bio-humorally, by echocardiography, explored with coronary angiography with the calculation of the SYNTAX score and with the performance of electrocardiogram and pulse wave. The obtained data were integrated in Excel sheets and statistically processed with the Python program. Results. The mortality rate in the patient group was 7% (7 deaths). Descriptively, of the deceased, 6 patients (86%) were male, and as thyroid status 1 hyperthyroid patient (14%), 3 hypothyroid patients (43%) and 3 patients (43%) normothyroid. There were 4 deaths (8%) in the group of patients with unstable angina and 3 deaths (8%) in the group of patients with myocardial infarction without ST-segment elevation. There were no deaths in the group of patients with acute myocardial infarction with ST-segment elevation. At follow-up, 41 patients (41%) were readmitted. Re-hospitalization was influenced by elevated values of mean blood pressure, diastolic blood pressure and C-reactive protein, unicoronary atherosclerotic disease and unstable angina at admission. At follow-up, the development of noncardiac events was noted in the evolution of patients, diabetes mellitus occurring in the majority, in almost a quarter of patients (22 patients, respectively 24% developed diabetes over time), 34% (19 patients) in euthyroidism and 8% (3 patients) dysthyroidism. Discussions. Predictive factors for the readmission of the patient with acute coronary syndrome are highlighted the following: increased level of C-reactive protein (p = 0.017), tricoronary vascular damage (p = 0.01), diastolic blood pressure greater than 80 mmHg (p = 0.025), and euthyroid status (p = 0.04). The probability of death for the patient with acute coronary syndrome rises to 66% in the presence of severe systolic dysfunction of the left ventricle (p = 0.006), and to 61% in the case of elevated values of hs troponin I (p = 0.008). In our study, the presence of dysthyroidism in the patient with acute coronary syndrome has a protective role in the development of diabetes in the first 5 years (p = 0.025). Conclusion. Dysthyroidism is associated with increased morbidity and mortality from cardiovascular disease.https://rjmp.com.ro/articles/2021.2/RJMP_2021_2_Art-20.pdfacute coronary syndromethyroid dysfunctionsyntax scoreoutcome