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Abstract
BackgroundAcute coronary syndromes (ACS; myocardial infarction or unstable angina) can induce posttraumatic stress disorder (PTSD), and ACS-induced PTSD may increase patients’ risk for subsequent cardiac events and mortality. Objective: To determine the prevalence of PTSD induced by ACS and to quantify the association between ACS-induced PTSD and adverse clinical outcomes using systematic review and meta-analysis. Data Sources: Articles were identified by searching Ovid MEDLINE, PsycINFO, and Scopus, and through manual search of reference lists.Methodology/Principal FindingsObservational cohort studies that assessed PTSD with specific reference to an ACS event at least 1 month prior. We extracted estimates of the prevalence of ACS-induced PTSD and associations with clinical outcomes, as well as study characteristics. We identified 56 potentially relevant articles, 24 of which met our criteria (N = 2383). Meta-analysis yielded an aggregated prevalence estimate of 12% (95% confidence interval [CI], 9%–16%) for clinically significant symptoms of ACS-induced PTSD in a random effects model. Individual study prevalence estimates varied widely (0%–32%), with significant heterogeneity in estimates explained by the use of a screening instrument (prevalence estimate was 16% [95% CI, 13%–20%] in 16 studies) vs a clinical diagnostic interview (prevalence estimate was 4% [95% CI, 3%–5%] in 8 studies). The aggregated point estimate for the magnitude of the relationship between ACS-induced PTSD and clinical outcomes (ie, mortality and/or ACS recurrence) across the 3 studies that met our criteria (N = 609) suggested a doubling of risk (risk ratio, 2.00; 95% CI, 1.69–2.37) in ACS patients with clinically significant PTSD symptoms relative to patients without PTSD symptoms.Conclusions/SignificanceThis meta-analysis suggests that clinically significant PTSD symptoms induced by ACS are moderately prevalent and are associated with increased risk for recurrent cardiac events and mortality. Further tests of the association of ACS-induced PTSD and clinical outcomes are needed.
Highlights
In recent decades, survival rates after acute coronary syndrome [Acute coronary syndromes (ACS); ST-segment elevation myocardial infarction (STEMI), non–ST-segment elevation myocardial infarction (NSTEMI) or unstable angina (UA)] have steadily increased [1,2]
Though the survival benefit conferred by the adoption of new technologies, interventions, and treatment guidelines is a great triumph of modern medicine, it may have increased the number of patients for whom survival means living with posttraumatic stress disorder (PTSD) due to the ACS event
Cardiologists and the broader medical community have become increasingly aware that psychological disorders, depression, are common in patients with ACS and are associated with adverse clinical outcomes [35,36,37,38,39]
Summary
Survival rates after acute coronary syndrome [ACS; ST-segment elevation myocardial infarction (STEMI), non–ST-segment elevation myocardial infarction (NSTEMI) or unstable angina (UA)] have steadily increased [1,2]. Posttraumatic stress disorder is an anxiety disorder initiated by an exposure to a traumatic event, such as combat, disaster, or sexual assault, and is characterized by symptoms such as re-experiencing (e.g., intrusive thoughts, nightmares), cognitive or behavioral avoidance of reminders of the event, and physiological hyperarousal. It is associated with abnormal amygdala, prefrontal cortex, and hippocampal function [4] as well as abnormal neuroendocrinologic characteristics [5]. Acute coronary syndromes (ACS; myocardial infarction or unstable angina) can induce posttraumatic stress disorder (PTSD), and ACS-induced PTSD may increase patients’ risk for subsequent cardiac events and mortality. Data Sources: Articles were identified by searching Ovid MEDLINE, PsycINFO, and Scopus, and through manual search of reference lists
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