title: Triggering of acute coronary occlusion by episodes of anger.
abstract: OBJECTIVE
  The aim of this study was to report the association between episodes of anger and acute myocardial infarction (MI) in patients with angiographically confirmed coronary occlusion.
  
  
  RESULTS
  313 participants with acute coronary occlusion (Thrombolysis In Myocardial Infarction 0 or 1 at emergency angiography) reported frequency of anger episodes in the 48 h prior to MI. In primary analysis, anger exposures within 2 h and 2-4 h prior to symptom onset were compared with subjects' own usual yearly exposure to anger using case-crossover methodology. Anger level ≥5 (on an anger scale of 1-7) was reported by seven (2.2%) participants within 2 h of MI. Compared with usual frequency, the relative risk of onset of MI symptoms occurring within 2 h of anger level ≥5 (defined as very angry) was 8.5 (95% confidence interval 4.1-17.6). Anger level <5 was not associated with onset of MI symptoms. Compared with 24-26 h pre MI, anxiety scores >75th percentile on State-Trait Personality Inventory were associated with a relative risk of 2.0 (95% confidence interval 1.1-3.8) and in those above the 90th percentile, the relative risk of MI symptom onset was 9.5 (95% confidence interval 2.2-40.8).
  
  
  CONCLUSIONS
  Findings confirm that episodes of intense anger, defined as being 'very angry, body tense, clenching fists or teeth' (within 2 h) are associated with increased relative risk for acute coronary occlusion. Additionally, increased anxiety was associated with coronary occlusion. Further study, including the role of potential modifiers, may provide insight into prevention of MI during acute emotional episodes.
authors.affiliation: Department of Cardiology, Royal North Shore Hospital, Sydney, Australia Sydney Nursing School, University of Sydney, Australia tom.buckley@sydney.edu.au.
authors.forename: Thomas
authors.initials: T
authors.lastname: Buckley
authors.affiliation: Department of Cardiology, Royal North Shore Hospital, Sydney, Australia.
authors.forename: Soon Y Soo
authors.initials: SY
authors.lastname: Hoo
authors.affiliation: Sydney Nursing School, University of Sydney, Australia.
authors.forename: Judith
authors.initials: J
authors.lastname: Fethney
authors.affiliation: Department of Cardiology, Royal North Shore Hospital, Sydney, Australia Sydney Medical School, University of Sydney, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Shaw
authors.affiliation: Department of Cardiology, Royal North Shore Hospital, Sydney, Australia Sydney Medical School, University of Sydney, Australia.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Hanson
authors.affiliation: Department of Cardiology, Royal North Shore Hospital, Sydney, Australia Sydney Medical School, University of Sydney, Australia.
authors.forename: Geoffrey H
authors.initials: GH
authors.lastname: Tofler
mesh_terms: D000208:Acute Disease; D000786:Anger / Q000502:physiology*; D054059:Coronary Occlusion / Q000209:etiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000523:psychology; D015985:Precipitating Factors; D011795:Surveys and Questionnaires
keywords: Trigger; anger; anxiety; coronary occlusion; myocardial infarction