Impact of Antithyroid Antibodies in Patients with Acute Coronary Syndrome in Kirkuk City View PDF

^*Raad Hassan Najim
Department Of Cardiology, College Of Medicine, Kirkuk University, Kirkuk, Iraq

^*Corresponding Author:

Raad Hassan Najim
Department Of Cardiology, College Of Medicine, Kirkuk University, Kirkuk, Iraq
Email:Raadpci@uokirkuk.edu.iq

Published on: 2020-04-08

Abstract

Background: Acute coronary syndrome is a medical syndrome affecting variety of patients causing high mortality and morbidity. Many studies considered its relation with antithyroid antibodies
Methods: 100 patients admitted to the hospital enrolled in the study presented either with ST elevation myocardial infarction or unstable angina/non ST elevation MI, ELIZA test were used to diagnose the presence of antithyroid antibodies with those patients.
Results: The study shows that only 5.9% of patients with STEMI have positive antithyroid antibodies in comparison to 3.0% of patients with UA/Non STEMI.
Conclusion: No significant correlation could be estimated or elicited between the presence of antithyroid antibodies and acute coronary syndrome.

Keywords

Acute Coronary Syndrome; Antithyroid Antibodies; Cardiovascular Diseases

Introduction

One of the most important leading causes for death all over the world is the cardiovascular diseases including variety of diseases extending from hypertension to myocardial infarctions and heart failure [1]. All over most of world countries it considered as one of the highest morbidities in number of admissions to the hospitals as well as percentages of morbidities and mortalities [2]. Many articles nowadays showing that there is effect of high levels of antithyroid antibodies on mortality and morbidity of patients with cardiovascular events such as systemic hypertension, heart failure, myocardial infarction and acute coronary syndrome [3].

High serum antithyroid antibodies seen in many diseases other than those diseases affecting thyroid gland itself, and the most prevalent and serious one is acute disorders affecting heart showing prognostic effect as well [4].

This effect is probably caused by either inflammatory response which is increased by circulating immunological cytokines or by direct effect on antibodies which may affect blood status causing clot formation leading to heart or coronary artery events [5].

Acute coronary syndrome including Non-ST elevation Myocardial infarction (NSTEMI), Unstable Angina & ST elevation MI(STEMI) [6] .

The aim of the current study is to evaluate the impact of antithyroid antibodies on patients with acute coronary syndrome (ACS).

Materials and Methods

The study involved 100 patients admitted from May 2018 to May 2019 to the coronary care unit in Azadi teaching hospital in Kirkuk city, diagnosed as having acute coronary syndrome by history, physicalexamination, electrocardiographic data, and cardiac enzymes. All patients with thyroid diseases or taking thyroid drug were excluded from the study.

Blood drawn from all patients after taking patient’s consent, Human Antithyroid peroxidase antibodies estimated by commercial ELIZA kits (Anti TPO test) with normal range below 35 IU/ml and antithyroglobulin antibodies with normal range less than 20 IU/ml.

Results

Table 1 summarize demographic characteristics of 100 patients enrolled in a study all of them with ACS,55% of them were males with mean age (60.3±2.3) and 45% were females with mean age (68.1±1.9), associated comorbidities shows that 62% of them had hypertensive heart diseases,71%were diabetics and 22% they already had previous coronary heart diseases. Regarding ACS they were divided to 67% of them under the category of STEMI the remaining 33% were UA/NSTEMI item as well.

Table 1: Demographic and general characteristics for ACS patients.

Variables	No=100 patients
Gender
Males	55(55%)
Females	45(45%)
Age
Males±SD	60.3±2.3
Females±SD	68.1±1.9
Comorbidities
Hypertension	62(62%)
Diabetes mellitus	71(71%)
Cororony heart disease	22(22%)
Type of ACS
STElevation MI	67(67%)
Unstable angina/Non STElevation MI	33(33%)

Table 2 shows that 4(5.98%) of patients with STEMI ACS were positive in regarding to antithyroid antibodies as a whole and 1(3.0%) were positive regarding those with UA/STEMI with no significant correlation regarding comparison to positive or negative results (P-values:0.06, 0.1, 0.55, and 0.34).

Table 2: Percentages of positive antithyroid antibodies in patients with different types of ACS.

Antithyroid Antibodies(100)	STEMI (67)	UA/NSTEM (33)	P-value
Positive	4(5.98%)	1(3.0%)	0.55
Negative	63 (49.02%)	32(97%)	0.34
P-value	0.06	0.1

Table 3 illustrate individual antibody values regarding those patients with ACs with positive antibodies showing that those patients with STEMI demonstrate that 50% of them were positive for Anti TPO AB and 50% of them had positive Antithyroglobulin Antibodies from all 4 patients with positive antibodies, 100% of patients with UA/STEMI Antibodies were positive for antithyroglobulin antibodies with no significant correlation (P-value =0.53 and 0.13).

Table 3: Individual percentages of antithyroid antibodies (Anti TPO and Antithyrogolbulin antibodies) among patients with ACS.

Types of ACS with +results	+Anti TPO	+Antithyroglobulin AB
STEMI (4)	2(50%)	2(50%)
UA/NSTEMI(1)	0(0%)	1(100%)
P-value	0.53	0.13

Discussion

Acute coronary syndrome is one of the most medical emergencies may affect people with predisposing factors such as hypertension and atherosclerosis [7]. Many studies discuss the correlation between Antithyroid antibodies and ACS [8-10].

Our study shows that there is no significant correlation between all types of ACS (STEMI, UA/NSTEMI) and all types of antithyroid antibodies (Anti TPO, Antithyroglobulin Antibodies). These results were similar and concordant to other studies shows the same results [11-16]. Also, these results came in concordant with other studies shows that the inflammatory cytokines and inflammatory response shows effect on homeostasis and clot formation causing STEMI mostly [17-22]. These results may be due small sample taken by our study so large sample recommended and more time to be prove or refuse these concepts.

Conclusion

No correlation between antithyroid antibodies and acute coronary syndrome were proved in our study.