title: Invasive coronary procedure use and outcomes among veterans with posttraumatic stress disorder: insights from the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program.
abstract: BACKGROUND
  Posttraumatic stress disorder (PTSD) is prevalent in the general population and US veterans in particular and is associated with an increased risk of developing coronary artery disease (CAD). We compared the patient characteristics and postprocedural outcomes of veterans with and without PTSD undergoing coronary angiography.
  
  
  METHODS
  This is a multicenter observational study of patients who underwent coronary angiography in Veterans Affairs hospitals nationally from October 2007 to September 2011. We described patient characteristics at angiography, angiographic results, and after coronary angiography, we compared risk-adjusted 1-year rates of all-cause mortality, myocardial infarction (MI), and revascularization by the presence or absence of PTSD.
  
  
  RESULTS
  Overall, of 116,488 patients undergoing angiography, 14,918 (12.8%) had PTSD. Compared with those without PTSD, patients with PTSD were younger (median age 61.9 vs 63.7; P < .001), had higher rates of cardiovascular risk factors, and were more likely to have had a prior MI (26.4% vs 24.7%; P < .001). Patients with PTSD were more likely to present for stable angina (22.4% vs 17.0%) or atypical chest pain (58.5% vs 48.6%) and less likely to have obstructive CAD identified at angiography (55.9% vs 62.2%; P < .001). After coronary angiography, PTSD was associated with lower unadjusted 1-year rates of MI (hazard ratio (HR), 0.86; 95% CI [0.75-1.00]; P = 0.04), revascularization (HR, 0.88; 95% CI [0.83-0.93]; P < .001), and all-cause mortality (HR, 0.66; 95% CI [0.60-0.71]; P < .001). After adjustment for cardiovascular risk, PTSD was no longer associated with 1-year rates of MI or revascularization but remained associated with lower 1-year all-cause mortality (HR, 0.91; 95% CI [0.84-0.99]; P = .03). Findings were similar after further adjustment for depression, anxiety, alcohol or substance use disorders, and frequency of outpatient follow-up.
  
  
  CONCLUSIONS
  Among veterans undergoing coronary angiography in the Veterans Affairs, those with PTSD were more likely to present with elective indications and less likely to have obstructive CAD. After coronary angiography, PTSD was not associated with adverse 1-year outcomes of MI, revascularization, or all-cause mortality.
authors.affiliation: VA Eastern Colorado Health Care System, Denver, CO; University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO; Colorado Cardiovascular Outcomes Research Consortium, Denver, CO. Electronic address: Steven.Bradley@va.gov.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Bradley
authors.affiliation: VA Eastern Colorado Health Care System, Denver, CO; Colorado Cardiovascular Outcomes Research Consortium, Denver, CO.
authors.forename: Maggie A
authors.initials: MA
authors.lastname: Stanislawski
authors.affiliation: VA Eastern Colorado Health Care System, Denver, CO; University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO; Colorado Cardiovascular Outcomes Research Consortium, Denver, CO.
authors.forename: David B
authors.initials: DB
authors.lastname: Bekelman
authors.affiliation: VA Eastern Colorado Health Care System, Denver, CO.
authors.forename: Lindsey L
authors.initials: LL
authors.lastname: Monteith
authors.affiliation: San Francisco VA Medical Center and University of California, San Francisco, CA.
authors.forename: Beth E
authors.initials: BE
authors.lastname: Cohen
authors.affiliation: University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO.
authors.forename: John H
authors.initials: JH
authors.lastname: Schilling
authors.affiliation: VA Puget Sound Healthcare System, Seattle, WA; University of Washington, Seattle, WA.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Hunt
authors.affiliation: University of Washington, Seattle, WA.
authors.forename: Debra
authors.initials: D
authors.lastname: Milek
authors.affiliation: VA Eastern Colorado Health Care System, Denver, CO; University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO; Colorado Cardiovascular Outcomes Research Consortium, Denver, CO.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Maddox
authors.affiliation: VA Eastern Colorado Health Care System, Denver, CO; University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO; Colorado Cardiovascular Outcomes Research Consortium, Denver, CO.
authors.forename: P Michael
authors.initials: PM
authors.lastname: Ho
authors.affiliation: VA Eastern Colorado Health Care System, Denver, CO; University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO; Colorado Cardiovascular Outcomes Research Consortium, Denver, CO.
authors.forename: Supriya
authors.initials: S
authors.lastname: Shore
authors.affiliation: VA Eastern Colorado Health Care System, Denver, CO; University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO; Colorado Cardiovascular Outcomes Research Consortium, Denver, CO.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Varosy
authors.affiliation: St Louis VA Medical Center and St Louis University, St Louis, MO.
authors.forename: Monica M
authors.initials: MM
authors.lastname: Matthieu
authors.affiliation: VA Eastern Colorado Health Care System, Denver, CO; University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO; Colorado Cardiovascular Outcomes Research Consortium, Denver, CO.
authors.forename: John S
authors.initials: JS
authors.lastname: Rumsfeld
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014728:Veterans