Anxiety and anger immediately prior to myocardial infarction and long-term mortality: Characteristics of high-risk patients.
Anxiety and anger immediately prior to myocardial infarction and long-term mortality: Characteristics of high-risk patients.
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心肌梗死前的焦虑和愤怒和长期死亡：高危患者的特征。
DOI：
10.1016/j.jpsychores.2016.12.001
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发表时间：
2017
影响因子：
4.7
通讯作者：
Mittleman,MurrayA
中科院分区：
文献类型：
--
作者：
Smeijers,Loes;Mostofsky,Elizabeth;Tofler,GeoffreyH;Muller,JamesE;Kop,WillemJ;Mittleman,MurrayA
急性高水平的愤怒和焦虑与随后两小时内心肌梗死（MI）的风险增加有关。在这些急性负面情绪之前的MI也可能具有不良的长期预后，但缺乏关于高危患者的信息。我们研究了是否年轻的年龄和女性性别与MI之前的负面情绪和年龄和性别是否适度随后增加的死亡风险MI之前的负面emotions.MethodsWe进行了二次分析的心肌梗死发病研究的决定因素（N = 2176，平均年龄= 60.1 ± 12.3岁，29.2%的妇女）。使用结构化访谈评估MI前（0 - 2小时）和MI前一天（24-26小时）的焦虑和愤怒。随后的10年全因死亡率使用美国国家死亡指数确定。结果MI前0-2 h期间的焦虑与年轻年龄（OR = 0.98，95%CI = 0.96-0.99每年）和女性性别（OR = 1.50，95%CI = 1.11-2.02）相关。MI前0-2 h的愤怒与年龄有关（OR = 0.95，95%CI = 0.94-0.96），与性别无关（OR = 0.93，95%CI = 0.67-1.28）。随访期间，580例（26.7%）患者死亡。如果在高度焦虑后立即发生MI，死亡率较高，尤其是≥ 65岁患者（HR = 1.80，95% CI = 1.28-2.54）与年轻患者（HR = 0.87，95% CI = 0.55-1.40; p-相互作用= 0.015）相比。其他与性或愤怒的相互作用并不显着。ConclusionsPatients与高焦虑或愤怒水平在关键的2小时内MI前比那些没有这样的情绪沉淀年轻。此外，MI前焦虑与年龄≥ 65岁患者的10年死亡风险升高相关。
ObjectiveAcute high levels of anger and anxiety are associated with an elevated risk of myocardial infarction (MI) in the following two hours. MIs preceded by these acute negative emotions may also have a poor long-term prognosis, but information about high-risk patients is lacking. We examined whether young age and female sex are associated with MIs that are preceded by negative emotions and whether age and sex moderate the subsequent increased mortality risk following MI preceded by negative emotions.MethodsWe conducted a secondary analysis of the Determinants of Myocardial Infarction Onset Study (N = 2176, mean age = 60.1 ± 12.3 years, 29.2% women). Anxiety and anger immediately prior to (0 − 2 h) MI and the day before (24–26 h) MI were assessed using a structured interview. Subsequent 10-year all-cause mortality was determined using the US National Death Index.ResultsAnxiety during the 0–2 h pre-MI period was associated with younger age (OR = 0.98,95% CI = 0.96–0.99 per year) and female sex (OR = 1.50,95% CI = 1.11–2.02). Anger in the 0–2 h pre-MI period was also associated with younger age (OR = 0.95,95% CI = 0.94–0.96) but not with sex (OR = 0.93,95% CI = 0.67–1.28). During follow-up, 580 (26.7%) patients died. Mortality rate was higher if MI occurred immediately after high anxiety, particularly in patients ≥ 65 years (HR = 1.80,95% CI = 1.28–2.54) vs. younger patients (HR = 0.87,95% CI = 0.55–1.40; p-interaction = 0.015). Other interactions with sex or anger were not significant.ConclusionsPatients with high anxiety or anger levels in the critical 2-hour period prior to MI are younger than those without such emotional precipitants. In addition, pre-MI anxiety is associated with an elevated 10-year mortality risk in patients aged ≥ 65 years.