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Multicenter Study
. 2011 Dec;45(12):1621-6.
doi: 10.1016/j.jpsychires.2011.07.004. Epub 2011 Jul 31.

Posttraumatic stress due to an acute coronary syndrome increases risk of 42-month major adverse cardiac events and all-cause mortality

Donald Edmondson  1 , Nina Rieckmann, Jonathan A Shaffer, Joseph E Schwartz, Matthew M Burg, Karina W Davidson, Lynn Clemow, Daichi Shimbo, Ian M Kronish
Affiliations
Multicenter Study

Posttraumatic stress due to an acute coronary syndrome increases risk of 42-month major adverse cardiac events and all-cause mortality

Donald Edmondson et al. J Psychiatr Res. 2011 Dec.

Abstract

Approximately 15% of patients with acute coronary syndromes (ACS) develop posttraumatic stress disorder (PTSD) due to their ACS event. We assessed whether ACS-induced PTSD symptoms increase risk for major adverse cardiac events (MACE) and all-cause mortality (ACM) in an observational cohort study of 247 patients (aged 25-93 years; 45% women) hospitalized for an ACS at one of 3 academic medical centers in New York and Connecticut between November 2003 and June 2005. Within 1 week of admission, patient demographics, Global Registry of Acute Coronary Events risk score, Charlson comorbidity index, left ventricular ejection fraction, and depression status were obtained. At 1-month follow-up, ACS-induced PTSD symptoms were assessed with the Impact of Events Scale-Revised. The primary endpoint was combined MACE (hospitalization for myocardial infarction, unstable angina or urgent/emergency coronary revascularization procedures) and ACM, which were actively surveyed for 42 months after index event. Thirty-six (15%) patients had elevated intrusion symptoms, 32 (13%) elevated avoidance symptoms, and 21 (9%) elevated hyperarousal symptoms. Study physicians adjudicated 21 MACEs and 15 deaths during the follow-up period. In unadjusted Cox proportional hazards regression analyses, and analyses adjusted for sex, age, clinical characteristics and depression, high intrusion symptoms were associated with the primary endpoint (adjusted hazard ratio, 3.38; 95% confidence interval, 1.27-9.02; p = .015). Avoidance and hyperarousal symptoms were not associated with the primary endpoint. The presence of intrusion symptoms is a strong and independent predictor of elevated risk for MACE and ACM, and should be considered in the risk stratification of ACS patients.

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Figures

Figure 1
Figure 1
Cox proportional hazards regression analysis predicted curve for patients with and without high levels of intrusion symptoms, adjusted for age, sex, Charlson comorbidity index score, Global Registry of Acute Coronary Events risk score, left ventricular ejection fraction, and depression symptom severity according to the Beck Depression Inventory. Also, the number of patients in each group who were at risk for MACE/ACM at each year are presented below the figure. Abbreviation: ACS, acute coronary syndrome.
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