Emotional disturbances and unfavorable events after myocardial infarction with ST-segment elevation: a «case — control» study

Abstract

A large volume of papers gives considerations of the effects of anxiety and depression on the onset and exacerbation of the course of cardiovascular diseases, however the majority of them was devoted to the conditions at their clinical stage and required the involvement of a psychiatrists in the investigational team. The nature of association of psychical and somatic state remains insufficiently studied, but it becomes increasingly actual. Objective — to investigate the association of the subclinical level of anxiety, depression and stress with the unfavorable events after 6 month observation after STEMI. Materials and methods. The «case­control» study involved 144 patients, from them 72 patients were included in the «case» group (STEMI patients with subclinical emotional disturbances) and 72 subjected referred to the «control» group, STEMI patients comparable with age, sex and cardiovascular risk factors. Emotional disturbances were assessed with DASS 21 questionnaire. The observations lasted for 6 months. The combined endpoint was assessed: the onset of heart failure in accordance with current recommendations [18], post-infarctional angina, cardiovascular death, hospitalization due to cardiovascular reasons. Results and discussion. The chance of cardiac end point cumulation before 6 months after STEMI was in 2.5 times higher in the group with emotional disturbances compared to the group without disorders, 95 % CI 1.12—5.33, р = 0.034. The development of heart failure significantly contributed to the cardiac end point development, OR 3.75, 95 % CI 1.12—10.61; р = 0.039. Conclusions. DASS 21 questionnaire can be sued as a reliable tool for diagnosing of emotional disturbances and possible prediction of the cardiovascular events.