Anxiety in the First Hours Matters: Acute State Anxiety as an Early Marker of Post-MI PTSD

Abstract

Introduction Acute myocardial infarction (AMI) is a traumatic experience for many patients affected. In addition to somatic stabilization in acute care, early emotional distress often occurs, but is rarely systematically recorded in the emergency medical setting. Previous research demonstrated that symptoms of post-traumatic stress disorder (PTSD) following AMI are associated with reduced treatment adherence, a higher incidence of recurrent cardiovascular events, and increased mortality. Against this background, the present study aimed to examine whether early anxiety symptoms assessed immediately after AMI are predictive of the development of post-traumatic stress symptoms 12 months after the index event.

Methods 128 AMI patients were recruited from the Department of Cardiology at Graz University Hospital. Their baseline mental state was assessed immediately after stabilization and transfer from the acute care using the State-Trait Anxiety Inventory (STAI).[1] One year after the index event, a structured telephone follow-up examination was conducted, in which 34 patients were included. Symptoms of post-traumatic stress disorder were assessed using clinical interviews (Clinician-Administered PTSD Scale for DSM-5 CAPS-5).[2]

Results Significant moderate correlations were found between state anxiety recorded immediately after AMI and post-traumatic stress symptoms after one year (r = 0.43, p = 0.011, R² = 0.19, see Figure 1). Patients with higher acute anxiety levels thus showed a significantly increased risk of long-term mental morbidity.

Discussion The results suggest that the emotional stress response in the acute phase of myocardial infarction has prognostic relevance. A brief psychological risk stratification as part of acute care could help to identify high-risk patients at an early stage. The implementation of low-threshold screening in the emergency department or intensive care unit appears feasible and could enable the early initiation of preventive psychosocial interventions.