Disección coronaria espontánea y alteraciones tiroideas

Abstract

Introduction and objectives: Thyroid hormone affects the metabolism of all tissues in the body. The aim of this study was to analyze the prevalence and implications of thyroid disorders in a cohort of consecutive patients with spontaneous coronary artery dissection (SCAD). Methods: In a first descriptive phase, all SCAD from 2 tertiary hospital centers were included, summarizing a total of 73 patients diagnosed with this pathology over more than a decade. In this first phase, demographic, comorbidities, clinical, laboratory, angiographic and prognostic parameters were analyzed. The high prevalence of thyroid disease, specifically hypothyroidism, was strikingly noteworthy, which led to a second analytical research phase. In this second phase, the characteristics and clinical evolution of euthyroid SCAD patients were compared with those of hypothyroid patients with SCAD. Finally, a third investigative phase was carried out to try to determine if the observed prevalence could be the result of chance, for this the prevalence of thyroid alterations and clinical characteristics of these patients were analyzed and compared in a case-control study with 73 patients with acute coronary syndrome (ACS) but without SCAD matched by age, gender and clinical presentation. Results: Mean age was 55 ± 12 years and 26% had hypothyroidism. Compared with patients with normal thyroid function, patients with SCAD and hypothyroidism were all women (100% vs 69%, P = .01), more frequently had dissection in distal (74% vs 41%, P = .03) and tortuous coronary segments (68% vs 41%, p = .03), and more frequently received conservative medical management (79% vs 41%, P = .007). During a mean clinical follow-up of 4.1 ± 3.8 years, 23% of the patients had adverse cardiac events irrespective of thyroid function status. The prevalence of hypothyroidism was higher in patients with SCAD than in matched patients with acute coronary syndrome without SCAD (26% vs 8%, P = .004). Conclusions: There is a high prevalence of hypothyroidism in patients with SCAD. Patients with SCAD and hypothyroidism are more frequently women, more frequently have distal dissections in tortuous vessels, and are more frequently managed with a conservative medical strategy.