Risk stratification in patients after acute coronary syndrome: the role of cardiovascular reactions to mental stress challenge

Abstract

Introduction: Recurrent acute coronary syndromes (ACS) usually are most common 1 year after cardiac event [1]. Therefore, early and accurate risk-stratification of patients after ACS is important. Currently, there are very few studies examining psychophysiological reactions to mental stress in patients with coronary artery disease (CAD), even though exaggerated cardiac reactivity to emotional stressors plays an essential role in the aetiology of cardiovascular pathology, and may act as a trigger for recurrent ACS [2]. While using laboratory induced stress, there is a possibility to differentiate those, who may have maladaptive exaggerated cardiac reactivity. The aim of our study was to evaluate sociodemographic, clinical and psychological characteristics in those with and without maladaptive exaggerated cardiac reactivity to mental stress. Methods: A cross-sectional study included CAD patients two weeks after experiencing ACS attending cardiac rehabilitation clinic. Sociodemographic, clinical and psychosocial risk factors were determined based on previously established guidelines [3], which included age, gender, education, diagnosis, arterial hypertension, medication use, New York Heart Association (NYHA) functional class, history of smoking, obesity (body mass index [BMI] > 30 kg/m2), and smoking habits. Psychological evaluation included subjectively measured mental distress, specifically symptoms of anxiety and depression (Hospital Anxiety and Depression Scale), as well as Type D Personality (Type D Scale-14), comprised of subscales of social inhibition and negative affectivity. Trier Social Stress Test (TSST) [4] was used to evaluate cardiovascular reactions to mental stress, during which systolic and diastolic blood pressure (BP), and heart rate were recorded. Patients with maladaptive exaggerated cardiac reactivity were classified based on established criteria for termination of physical stress testing in[...].