Dervin Ariansyah

Introduction
Background
Thyroid hormone affects every cell,
tissue, and organ in the body
include the cardiovascular system
Insidence
a higher prevalence of
hypothyroidism in elderly women
(24% in women > 60 years). Up to
60% of those with hypothyroidism
are unaware of their condition

Clinical
Research
Purpose The Aim
to examine the association Evaluating risk and medically
between hypothyroidism and major optimizing patients prior to PCI is
adverse cardiovascular and essential to limiting complications
cerebral events (MACCE) in and improving prognosis
patients undergoing PCI

2
 Methods
Collecting
Timescape
data
All patients who undergo A clinical research nurse
PCI contact all patients after 6
at Mayo Clinic and 12 months and
annually to ascertain
relevant follow up
information
Data
Database
Records from outside
Integrity
The supervisor randomly
hospitals relating to audits 10% of all records to
adverse events are also ensure data are collected
collected accurately
Institutional
Review
Approval for this study was
obtained from the
Institutional Review Board
of the Mayo Foundation
Figure 1
Patient selection process and study
protocol.
Figure 2
Patient selection process by thyroid-stimulating hormone levels.
 Methods
Data
Collection
Information on patient was
abstracted from patients’
electronic medical records by
a single investigator (M.Z.)
blinded to PCI data

Registry
Information on adverse
cardiovascular events was
collected prospectively as
Clinical
part of the Mayo Clinic PCI follow-up
Major adverse cardiovascular
registry
and cerebral event was defined
as cardiac death, myocardial
infarc- tion (MI), target-vessel
revascularization (TVR), stroke,
and heart failure
 Methods

 30% luminal diameter reduction

 Both baseline and followup
 Selected 102 patients from
the hypothyroid group and
306 patients from the
euthyroid group
coronary angiograms were
analysed with quantitative
coronary angiography
(QCA) by a single trained
investigator (M.Z.) blinded
to each patient’s
hypothyroid status using
QAngio XA software
of a pre-existing stenosis of <
50%
 progression of any lesion to total
occlusion
 ‘new’ lesions with a 30% luminal
diameter reduction in a segment
that was normal at the first
angiogram
Results
Results
Results
Results
Results
Results
Results
Results
Results
Results
 Discussion
Hypothyroidism and
MACCE may lead to an increased risk of
hypothyroidism
adverse cardiovascular events through
endothelial dysfunction; however, the precise
Thyroid mechanisms require further clarification

status by TSH
and MACCE Thyroid
SCH is indeed a clinically important
entity that requires identification and replacement
management, as its risk is
comparable with that of overt therapy
the risk of MACCE was
hypothyroidism
significantly lower in patients with
adequate replacement on TRT.
Study Limitation

Results of this study may This study is limited by its

be influenced by observational design and its
confounding variables not relatively modest sample
accounted for in our size
analyses

Most subjects who had

not able to identify other
documented TSH levels
non-cardiac causes of
had no FT4 levels
death such as
available, limiting the
malignancy, which may
assessment of thyroid
be competing risks
status to a single TSH
against cardiovascular
value
death
 Conclusions

Hypothyroidism is associated with a higher incidence of

MACCE compared with euthyroidism in patients
undergoing PCI. Maintaining adequate control on TRT is
beneficial in preventing cardiovascular events
Thank you!
Any Questions?