Posttraumatic stress due to an acute coronary syndrome increases risk of 42-month major adverse cardiac events and all-cause mortality
Posttraumatic stress due to an acute coronary syndrome increases risk of 42-month major adverse cardiac events and all-cause mortality
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DOI：
10.1016/j.jpsychires.2011.07.004
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发表时间：
2011-12-01
影响因子：
4.8
通讯作者：
Kronish, Ian M.
中科院分区：
文献类型：
--
作者：
Edmondson, Donald;Rieckmann, Nina;Kronish, Ian M.
大约15%的急性冠状动脉综合征（ACS）患者由于ACS事件而发展为创伤后应激障碍（PTSD）。我们在2003年11月至2005年6月在纽约和康涅狄格州的3个学术医疗中心之一进行的一项观察性队列研究中评估了ACS诱导的PTSD症状是否增加了主要不良心脏事件（MACE）和全因死亡率（ACM）的风险。在入院后1周内，获得患者人口统计学资料、急性冠脉事件全球登记风险评分、Charlson合并症指数、左心室射血分数和抑郁状态。在1个月的随访中，ACS引起的PTSD症状进行了评估与事件的影响量表修订。主要终点为MACE（因心肌梗死、不稳定型心绞痛或紧急/急诊冠状动脉血运重建术住院）和ACM的组合，在索引事件后42个月进行积极调查。36例（15%）患者出现侵入症状升高，32例（13%）患者出现回避症状升高，21例（9%）患者出现过度觉醒症状升高。研究医生在随访期间裁定了21例MACE和15例死亡。在未校正的考克斯比例风险回归分析中，以及校正了性别、年龄、临床特征和抑郁的分析中，高侵入性症状与主要终点相关（校正的风险比，3.38; 95%置信区间，1.27-9.02; p = 0.015）。回避和过度觉醒症状与主要终点无关。侵入症状的存在是MACE和ACM风险升高的一个强有力的独立预测因素，应在ACS患者的风险分层中予以考虑。(C)2011爱思唯尔有限公司保留所有权利。
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. (C) 2011 Elsevier Ltd. All rights reserved.