Abstract 12982: Post-traumatic Stress Disorder (PTSD) Symptoms Predict Worse Long-term Cardiovascular Prognosis in Post-Acute Coronary Syndrome (ACS) Patients
Background: Approximately 15%; of ACS patients develop PTSD, which consists of 3 symptom clusters: intrusive thoughts or flashbacks; avoidance of trauma reminders; and hyperarousal. Limited evidence suggests that PTSD predicts ACS recurrence, but no study has assessed the independent predictive value of each symptom cluster. Based on previous evidence of a relationship between intrusions and cardiovascular risk markers, we hypothesized that intrusions would predict ACS recurrence/mortality over a 42-month follow-up.
Methods: Hospitalized patients (N = 261) were enrolled within 1-week of ACS. Incidence of fatal and non-fatal cardiovascular events was determined during a 42-month follow-up period. PTSD symptoms were assessed 1-month post-ACS, using the Impact of Events Scale-Revised (IES-R), which provides a total score and subscale scores for the 3 symptom clusters (Intrusions, Avoidance, and Arousal); total scale score ≥ 33 corresponds to PTSD diagnosis, so subscale scores ≥ 11 were considered high). Covariates for Cox regression analyses included age, gender, Global Registry of Acute Coronary Events (GRACE) risk score, Charlson comorbidity index, left ventricular ejection fraction, and Beck Depression Inventory.
Results: Fifteen percent (n=39) of the cohort reported high Intrusions symptoms. Nine percent(n=22) had a non-fatal recurrent ACS events and 9% (n=22) died during follow-up. Adding the PTSD symptom clusters improved the model over the covariates (p=.05), but only the Intrusions symptom cluster score was significant (HR=3.35, 95% CI 1.27–8.8, p=.015).
Conclusions: Post-ACS patients who report intrusive thoughts about the ACS 1 month after hospitalization are at increased risk for recurrent events and mortality, independent of other important prognostic factors. Future studies should examine which patients are vulnerable to this class of PTSD symptoms after ACS and test targeted interventions to improve prognosis.
- © 2010 by American Heart Association, Inc.