Acute Stress Disorder Symptoms Predict All-Cause Mortality Among Myocardial Infarction Patients: a 15-Year Longitudinal Study.
BACKGROUND
Studies have recognized myocardial infarction (MI) as a risk for acute stress disorder (ASD), manifested in dissociative, intrusive, avoidant, and hyperarousal symptoms during hospitalization.


OBJECTIVE
This study examined the prognostic role of ASD symptoms in predicting all-cause mortality in MI patients over a period of 15 years.


METHODS
One hundred and ninety-three MI patients filled out questionnaires assessing ASD symptoms during hospitalization. Risk factors and cardiac prognostic measures were collected from patients' hospital records. All-cause mortality was longitudinally assessed, with an endpoint of 15 years after the MI.


RESULTS
Of the participants, 21.8 % died during the follow-up period. The decedents had reported higher levels of ASD symptoms during hospitalization than had the survivors, but this effect became nonsignificant when adjusting for age, sex, education, left ventricular ejection fraction, and depression. A series of analyses conducted on each of the ASD symptom clusters separately indicated that-after adjusting for age, sex, education, left ventricular ejection fraction, and depression-dissociative symptoms significantly predicted all-cause mortality, indicating that the higher the level of in-hospital dissociative symptoms, the shorter the MI patients' survival time.


CONCLUSIONS
These findings suggest that in-hospital dissociative symptoms should be considered in the risk stratification of MI patients.
The Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, 69978, Israel. karnig@post.tau.ac.il.
Karni
K
Ginzburg
Private Practice, Tel Aviv, Israel.
Ilan
I
Kutz
Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Bella
B
Koifman
Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Arie
A
Roth
Department of Cardiology, Edith Wolfson Medical Center, Tel Aviv, Israel.
Michael
M
Kriwisky
Department of Cardiology, Meir General Hospital, Kfar Saba, Israel.
Daniel
D
David
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.|Lev Hasharon Psychiatric Hospital, Tzur Moshe, Israel.
Avi
A
Bleich
D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality* / Q000523:psychology; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D040701:Stress Disorders, Traumatic, Acute / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000523:psychology; D063189:Symptom Assessment
Acute stress disorder; All-cause mortality; Dissociation; Myocardial infarction