title: Posttraumatic stress due to an acute coronary syndrome increases risk of 42-month major adverse cardiac events and all-cause mortality.
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.
authors.affiliation: Center for Behavioral Cardiovascular Health, Columbia University Medical Center, NY, USA. donald.edmondson@columbia.edu
authors.forename: Donald
authors.initials: D
authors.lastname: Edmondson
authors.forename: Nina
authors.initials: N
authors.lastname: Rieckmann
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Shaffer
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Schwartz
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Burg
authors.forename: Karina W
authors.initials: KW
authors.lastname: Davidson
authors.forename: Lynn
authors.initials: L
authors.lastname: Clemow
authors.forename: Daichi
authors.initials: D
authors.lastname: Shimbo
authors.forename: Ian M
authors.initials: IM
authors.lastname: Kronish
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications* / Q000401:mortality*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000401:mortality* / Q000523:psychology; D002423:Cause of Death; D005260:Female; D006760:Hospitalization; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000523:psychology; D016016:Proportional Hazards Models; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology* / Q000401:mortality*; D013686:Telemetry; D013997:Time Factors