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. 2025 Jul 2:16:1543378.
doi: 10.3389/fendo.2025.1543378. eCollection 2025.

Predicting major cardiac and cerebrovascular events in acute coronary syndrome patients using the thyroid hormone sensitivity index

Hui He #  1   2 , Jun Wang #  1 , Long Xia #  3 , Tao Ye  3 , Yan Luo  3 , Qiang Chen  3 , Qiao Feng  3 , Xiufen Peng  3 , Maoling Jiang  3 , Hanxiong Liu  3 , Tao Xiang #  4 , Shiqiang Xiong #  3 , Lin Cai #  1   3
Affiliations

Predicting major cardiac and cerebrovascular events in acute coronary syndrome patients using the thyroid hormone sensitivity index

Hui He et al. Front Endocrinol (Lausanne). .

Abstract

Background and aim: The thyroid hormone sensitivity index provides a new perspective for investigating nuanced alterations in thyroid function in cardiovascular disorders. However, the predictive value of thyroid hormone sensitivity indices for adverse events following percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) patients remains unknown. This study aimed to investigate the predictive value of thyroid sensitivity indices for major adverse cardiac and cerebrovascular events (MACCEs) in these patients.

Methods and results: A total of 431 patients were included in the analysis. Thyroid hormone sensitivity indices were calculated using the thyroid-stimulating hormone index (TSHI), thyrotrophic thyroxine resistance index (TT4RI), thyroid feedback quantile-based index (TFQI), and parametric thyroid feedback quantile-based index (PTFQI). During the median follow-up period, 50 (11.60%) patients experienced MACCEs. Multivariate Cox regression analysis revealed that TSHI (HR 1.277, 95% CI 1.110-1.468, P<0.001), TT4RI (HR 1.002, 95% CI 1.001-1.003, P<0.001), TFQI (HR 1.130, 95% CI 1.043-1.224, P=0.003), and PTFQI (HR 1.237, 95% CI 1.107-1.383, P<0.001) were independent predictors of MACCEs. The area under the ROC curve (AUROC) revealed that PTFQI had the highest predictive value (AUROC =0.688, 95% CI: 0.595-0.780; P < 0.001). Adding PTFQI to the GRACE score can enhance the risk prediction of MACCEs in ACS patients undergoing PCI, AUROC = 0.759 (95% CI 0.676-0.842, P < 0.001) vs AUROC = 0.646 (95% CI 0.563-0.729, P = 0.001), and there is a significant difference (P = 0.0108). Subgroup analysis indicated that PTFQI had a more significant predictive value for MACCEs in males and patients with abnormal blood glucose.

Conclusion: Thyroid hormone sensitivity indices are associated with a greater risk of MACCEs in patients with ACS following PCI.

Keywords: acute coronary syndrome; major adverse cardiac and cerebrovascular events; percutaneous coronary intervention; prognosis; thyroid hormone sensitivity.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the study population. ACS, acute coronary syndrome; PCI, percutaneous coronary intervention; MACCEs, major adverse cardiac and cerebrovascular events; MI, myocardial infarction.
Figure 2
Figure 2
Cumulative incidence of the primary endpoint events according to the tertiles of thyroid hormone sensitivity indices. The groups were stratified by the tertiles of thyroid hormone sensitivity indices. Kaplan–Meier curves for the incidence of the primary endpoint among the 3 study groups based on TT4RI (A), TSHI (B), TFQI (C), and PTFQI (D). TT4RI, thyrotrophic thyroxine resistance index; TSHI, thyroid-stimulating hormone index; TFQI, thyroid feedback quantile-based index; PTFQI, parametric thyroid feedback quantile-based index.
Figure 3
Figure 3
ROC curve analysis of thyroid hormone sensitivity indices for MACCEs. The area under the ROC curve (AUROC) of for thyroid hormone sensitivity indices predicting the occurrence of MACCEs. TSHI was 0.676 (95% CI: 0.578 - 0.774; P<0.001); TT4RI was 0.674 (95% CI: 0.577 - 0.771; P<0.001); TFQI was 0.655 (95% CI: 0.566 - 0.744; P<0.001); PTFQI was 0.688 (95% CI: 0.595 - 0.780; P<0.001). MACCEs, major adverse cardiac and cerebrovascular events; ROC, receiver operating characteristic; PCI, percutaneous coronary intervention. TSHI, thyroid-stimulating hormone index; TT4RI, thyrotrophic thyroxine resistance index; TFQI, thyroid feedback quantile-based index; PTFQI, and parametric thyroid feedback quantile-based index.
Figure 4
Figure 4
ROC curve analysis for predicting MACCEs by adding PTFQI to the GRACE risk score. The AUROC for PTFQI, GRACE score, and the combined PTFQI+GRACE score model in predicting MACCEs were 0.688 (95% CI: 0.595 - 0.780; P<0.001), 0.646 (95% CI: 0.563-0.729; P=0.001), and 0.759 (95% CI: 0.676-0.842; P<0.001), respectively. PTFQI, parametric thyroid feedback quantile-based index; GRACE score, the Global Registry of Acute Coronary Events risk score; MACCEs, major adverse cardiac and cerebrovascular events.
Figure 5
Figure 5
Subgroups analyses of PTFQI for MACCEs. HR, hazard ratio; CI, confidence interval; ABG, Abnormal blood glucose; NGR, normal glucose regulation; MVD, multivessel disease.
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