Saint Luke's Mid America Heart Institute, Kansas City, Missouri 64111, USA.
J Am Coll Cardiol. 2012 Oct 30;60(18):1756-63. doi: 10.1016/j.jacc.2012.06.044. Epub 2012 Oct 3.
This study sought to determine the association of chronic stress with long-term adverse outcomes after acute myocardial infarction (AMI).
Chronic stress has been shown to be associated with the development of cardiovascular disease and, in the case of particular types of stress such as job and marital strain, with recurrent adverse events after AMI. Little is known, however, about the association of chronic stress with mortality and adverse health status outcomes in a general AMI population.
In a cohort of 4,204 AMI patients from 24 U.S. hospitals completing the Perceived Stress Scale-4 (sum scores ranging from 0 to 16) during hospitalization, moderate/high stress over the previous month was defined as scores in the top 2 quintiles (scores of 6 to 16). Detailed data on sociodemographics, psychosocial status, and clinical characteristics were collected at baseline. Outcomes included patients' 1-year health status, assessed with the Seattle Angina Questionnaire, Short Form-12, and EuroQol Visual Analog Scale, and 2-year mortality.
AMI patients with moderate/high stress had increased 2-year mortality compared with those having low levels of stress (12.9% vs. 8.6%; p < 0.001). This association persisted after adjusting for sociodemographics, clinical factors (including depressive symptoms), revascularization status, and GRACE (Global Registry of Acute Coronary Events) discharge risk scores (hazard ratio: 1.42: 95% confidence interval: 1.15 to 1.76). Furthermore, moderate/high stress was independently associated with poor 1-year health status, including a greater likelihood of angina, worse disease-specific and generic health status, and worse perceived health (p < 0.01 for all).
Moderate/high perceived stress at the time of an AMI is associated with adverse long-term outcomes, even after adjustment for important confounding factors. Future studies need to examine whether stress mediates observed racial and socioeconomic disparities and whether novel interventions targeting chronic stress and coping skills can improve post-AMI outcomes.
本研究旨在探讨慢性应激与急性心肌梗死（AMI）后长期不良结局的关系。
慢性应激已被证明与心血管疾病的发生有关，而对于某些特定类型的应激，如工作和婚姻压力，与 AMI 后再次发生不良事件有关。然而，在一般 AMI 人群中，慢性应激与死亡率和不良健康状况结局的关系知之甚少。
在来自美国 24 家医院的 4204 名 AMI 患者队列中，在住院期间完成了感知压力量表-4（总分范围为 0 至 16），在过去一个月内，中/高压力被定义为前 2 个五分位数（得分 6 至 16）的患者。在基线时收集了社会人口统计学、心理社会状况和临床特征的详细数据。结果包括患者的 1 年健康状况，采用西雅图心绞痛问卷、简明健康调查问卷-12 和欧洲五维健康量表进行评估，以及 2 年死亡率。
与低压力水平的患者相比，中/高压力水平的 AMI 患者的 2 年死亡率更高（12.9%比 8.6%；p<0.001）。这种关联在调整了社会人口统计学、临床因素（包括抑郁症状）、血运重建状态和 GRACE（全球急性冠状动脉事件注册）出院风险评分后仍然存在（风险比：1.42；95%置信区间：1.15 至 1.76）。此外，中/高压力与 1 年健康状况不佳独立相关，包括心绞痛发生的可能性更高、疾病特异性和一般性健康状况更差以及对健康的感知更差（所有 p<0.01）。
AMI 时感知到的中度/高度压力与不良的长期结局相关，即使在调整了重要的混杂因素后也是如此。未来的研究需要探讨压力是否介导了观察到的种族和社会经济差异，以及针对慢性应激和应对技能的新干预措施是否可以改善 AMI 后的结局。
