title: Non-fatal cardiovascular outcome in patients with posttraumatic stress symptoms caused by myocardial infarction.
abstract: OBJECTIVE
  Posttraumatic stress disorder (PTSD) prospectively increases the risk of incident cardiovascular disease (CVD) independent of other risk factors in otherwise healthy individuals. Between 10% and 20% of patients develop PTSD related to the traumatic experience of myocardial infarction (MI). We investigated the hypothesis that PTSD symptoms caused by MI predict adverse cardiovascular outcome.
  
  
  METHODS
  We studied 297 patients (61 ± 10 years, 83% men) who self-rated PTSD symptoms attributable to a previous index MI. Non-fatal CVD-related hospital readmissions (i.e. recurrent MI, elective and non-elective intracoronary stenting, bypass surgery, pacemaker implantation, cardiac arrhythmia, cerebrovascular event) were assessed at follow-up. Cox proportional hazard models controlled for demographic factors, coronary heart disease severity, major CVD risk factors, cardiac medication, and mental health treatment.
  
  
  RESULTS
  Forty-three patients (14.5%) experienced an adverse event during a mean follow-up of 2.8 years (range 1.3-3.8). A 10 point higher level in the PTSD symptom score (mean 8.8 ± 9.0, range 0-47) revealed a hazard ratio (HR) of 1.42 (95% CI 1.07-1.88) for a CVD-related hospital readmission in the fully adjusted model. A similarly increased risk (HR 1.45, 95% CI 1.07-1.97) emerged for patients with a major or unscheduled CVD-related readmission (i.e. when excluding patients with elective stenting).
  
  
  CONCLUSIONS
  Elevated levels of PTSD symptoms caused by MI may adversely impact non-fatal cardiovascular outcome in post-MI patients independent of other important prognostic factors. The possible importance of PTSD symptoms as a novel prognostic psychosocial risk factor in post-MI patients warrants further study.
authors.affiliation: Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland. roland.vonkaenel@insel.ch
authors.forename: Roland
authors.initials: R
authors.lastname: von Känel
authors.forename: Roman
authors.initials: R
authors.lastname: Hari
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Schmid
authors.forename: Lina
authors.initials: L
authors.lastname: Wiedemar
authors.forename: Erika
authors.initials: E
authors.lastname: Guler
authors.forename: Jürgen
authors.initials: J
authors.lastname: Barth
authors.forename: Hugo
authors.initials: H
authors.lastname: Saner
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schnyder
authors.forename: Stefan
authors.initials: S
authors.lastname: Begré
mesh_terms: D002318:Cardiovascular Diseases / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D010359:Patient Readmission; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000209:etiology* / Q000503:physiopathology*