Abstract 13055: Invasive Coronary Procedure Use and Outcomes among Patients with Post-Traumatic Stress Disorder: Insights from the VA CART Program
Background: Studies suggest post-traumatic stress disorder (PTSD) is associated with increased risk of incident coronary disease. However, among patients undergoing invasive coronary procedures, it is unknown if PTSD is associated with differences in presenting characteristics and post-procedural outcomes.
Methods: We evaluated all coronary angiograms performed nationally in the VA between 2007 and 2010 using the VA CART Program. We compared patient characteristics, clinical presentation, and angiographic results by presence of PTSD (defined by clinical and administrative data). Among patients with obstructive CAD by angiography, defined as ≥ 50% left main stenosis or ≥ 70% stenosis in any other major epicardial coronary, we assessed risk-adjusted one-year rates of all-cause mortality, myocardial infarction (MI), and revascularization.
Results: Overall, 116,527 patients underwent angiography of which 14,925 (12.8%) had PTSD diagnoses. Compared to those without PTSD, patients with PTSD were younger (median age 61.9 vs 63.7, P≤.001), had higher rates of cardiovascular risk factors, including smoking (67.1% vs 57.7%, P≤.001), hypertension (89.1% vs 87.1%, P≤.001), hyperlipidemia (88.6% vs 84.1%, P≤.001), and diabetes (48.4% vs 43.9%, P≤.001), and more likely to have a prior MI (26.4% vs 24.7%, P≤.001). Patients with PTSD were more likely to present with stable angina (22.4% vs 17.0%, P≤.001) and less likely to have obstructive CAD identified at angiography (55.9% vs 62.2%, P≤.001). Among the 71,509 patients with obstructive CAD, PTSD was not associated with risk-adjusted one-year rates of MI (OR 0.96; 95% CI 0.82-1.13; P=0.66) or revascularization (OR 0.95; 95% CI 0.89-1.02; P=0.13), but was associated with lower risk-adjusted one-year all-cause mortality (OR 0.88 95% CI 0.79-0.98; P=0.02).
Conclusions: Among patients undergoing angiography in the VA, patients with PTSD were more likely to present with non-acute indications and less likely to have obstructive CAD, suggesting a lower clinical threshold for use of angiography among patients with PTSD. Among patients with obstructive CAD at angiography, PTSD was not associated with adverse one-year outcomes for MI or revascularization, but was associated with better one-year survival.
- © 2013 by American Heart Association, Inc.