Psychosocial Predictors of Death for Low-Risk Patients After a First Myocardial Infarction

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Abstract
This study aimed to identify whether psychosocial variables predicted mortality 7 years after a first myocardial infarction among patients who did not undergo revascularization. The study population consisted of 222 men aged 30 to 60 years who entered an inpatient rehabilitation program a mean of 7 weeks after a first myocardial infarction. Medical data were obtained from the patients and their physicians at entry to the rehabilitation center and 1 year later. Psychosocial and medical variables were obtained from the patient by questionnaires at entry 1 and 7 years later. Follow-up evaluation was 96% complete. Statistical analyses are reported using odds ratios (OR). The 7-year mortality rate was 10.4%; the reinfarction rate was 9%; the hospital readmission rate was 32.3%; and 39.2% of the patients underwent a subsequent revascularization procedure, either coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA). The most important psychosocial predictors for death at 7 years identified with logistic regression analyses were lack of partnership (OR, 3.46), anxiety (OR, 1.19), and depression (OR, 1.04). Medical predictors of 7-year mortality were severity of infarction (OR, 2.86) and the number of coronary risk factors (OR, 1.77). Survival in a group of low-risk male patients 7 years after a first myocardial infarction was predicted by the following psychological and social variables: lack of partnership, depression, and anxiety. Although it is unknown whether the risk of dying 7 years after an initial myocardial infarction can be reduced by therapeutic interventions, these data reinforce the importance of special attention for patients with these psychosocial characteristics.