Iranian Heart Association Iranian Heart Journal 27 3 2026 07 01 Prognostic Implications of Subclinical Hypothyroidism in ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention 49 59 246579 EN Osama Ahmed Amin Department of Cardiology, Beni-Suef University, Egypt. 0000-0001-5461-9720 Hazem Shalaby Department of Cardiology, Tanta University, Egypt. 0000-0001-7859-170X Haidy Khattab Department of Medical Physiology, Tanta University, Egypt. Ahmed Hamam Department of Endocrinology and Metabolism, Armed Forces College of Medicine, Egypt. 0000-0002-6190-0323 Ahmed Farouk Alaarag Department of Cardiology, Tanta University, Egypt. 0000-0002-6596-4834 Journal Article 2025 09 28 Background: Subclinical hypothyroidism (SCH), characterized by elevated thyroid-stimulating hormone with normal free thyroxine (FT4), is a potential cardiovascular risk factor. The effect of SCH on outcomes in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) has received limited investigation. We aimed to evaluate the association between SCH and anti–thyroid peroxidase antibody (anti-TPO) positivity with no-reflow and acute heart failure (HF) in patients with STEMI after PCI. Methods: This prospective cohort study enrolled 303 patients with STEMI undergoing primary PCI at 2 tertiary centers. SCH was defined as thyroid-stimulating hormone levels greater than 4.5 mIU/L with normal FT4 (0.8–1.8 ng/dL). Outcomes included no-reflow (Thrombolysis in Myocardial Infarction [TIMI] flow ≤ 2 or corrected TIMI frame count > 27) and acute HF (Killip class > II). Multivariate logistic regression was used to assess SCH and anti-TPO positivity as predictors of no-reflow and acute HF, adjusting for age, sex, diabetes, hypertension, smoking, Gensini score, thrombus burden, preprocedural TIMI flow, ischemic time, and anti-TPO status. Results: Patients with SCH (n = 37, 12.2%) were more likely to be female (51.4% vs 32.0% in euthyroid patients; P = .02) and anti-TPO positive (83.8% vs 6.4%; P < .001). SCH was associated with higher Gensini scores (P = .02), increased no-reflow, and acute HF with Killip class greater than II. SCH and left ventricular ejection fraction could predict the occurrence of acute HF (P = .04 and P < .001, respectively). SCH and anti-TPO positivity (P = .03 and P = .01, respectively) could be associated with increased no-reflow. Conclusions: SCH and anti-TPO positivity could be associated with adverse outcomes in patients with STEMI post-PCI, suggesting a role for thyroid function screening in risk stratification. (Iranian Heart Journal 2026; 27(3): 49-59)

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