Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
J Cardiol. 2011 Jul;58(1):61-8. doi: 10.1016/j.jjcc.2011.02.007. Epub 2011 Apr 13.
Posttraumatic stress disorder (PTSD) prospectively increases the risk of incident cardiovascular disease (CVD) independent of other risk factors in otherwise healthy individuals. Between 10% and 20% of patients develop PTSD related to the traumatic experience of myocardial infarction (MI). We investigated the hypothesis that PTSD symptoms caused by MI predict adverse cardiovascular outcome.
We studied 297 patients (61 ± 10 years, 83% men) who self-rated PTSD symptoms attributable to a previous index MI. Non-fatal CVD-related hospital readmissions (i.e. recurrent MI, elective and non-elective intracoronary stenting, bypass surgery, pacemaker implantation, cardiac arrhythmia, cerebrovascular event) were assessed at follow-up. Cox proportional hazard models controlled for demographic factors, coronary heart disease severity, major CVD risk factors, cardiac medication, and mental health treatment.
Forty-three patients (14.5%) experienced an adverse event during a mean follow-up of 2.8 years (range 1.3-3.8). A 10 point higher level in the PTSD symptom score (mean 8.8 ± 9.0, range 0-47) revealed a hazard ratio (HR) of 1.42 (95% CI 1.07-1.88) for a CVD-related hospital readmission in the fully adjusted model. A similarly increased risk (HR 1.45, 95% CI 1.07-1.97) emerged for patients with a major or unscheduled CVD-related readmission (i.e. when excluding patients with elective stenting).
Elevated levels of PTSD symptoms caused by MI may adversely impact non-fatal cardiovascular outcome in post-MI patients independent of other important prognostic factors. The possible importance of PTSD symptoms as a novel prognostic psychosocial risk factor in post-MI patients warrants further study.
创伤后应激障碍（PTSD）独立于其他风险因素，可增加健康个体发生心血管疾病（CVD）的风险。在因心肌梗死（MI）而经历创伤的患者中，有 10%至 20%会出现 PTSD。我们假设 MI 引起的 PTSD 症状可预测不良心血管结局。
我们研究了 297 名（61±10 岁，83%为男性）自我评估 PTSD 症状与先前指数 MI 有关的患者。非致命性 CVD 相关的医院再入院（即复发性 MI、择期和非择期冠状动脉支架置入术、旁路手术、起搏器植入、心律失常、脑血管事件）在随访中进行评估。Cox 比例风险模型控制了人口统计学因素、冠心病严重程度、主要 CVD 危险因素、心脏药物和精神健康治疗。
在平均 2.8 年（范围 1.3-3.8 年）的随访中，43 名患者（14.5%）发生不良事件。PTSD 症状评分增加 10 分（平均 8.8±9.0，范围 0-47），在完全调整的模型中，CVD 相关医院再入院的风险比（HR）为 1.42（95%CI 1.07-1.88）。对于主要或非计划的 CVD 相关再入院（即排除择期支架置入术患者）的患者，风险也同样增加（HR 1.45，95%CI 1.07-1.97）。
MI 引起的 PTSD 症状升高可能会对 MI 后患者的非致命性心血管结局产生不利影响，独立于其他重要预后因素。PTSD 症状作为 MI 后患者的一种新型预后心理社会风险因素的重要性值得进一步研究。
