Unlike other types of acute myocardial infarctions that are traditionally caused by atherosclerosis, spontaneous coronary artery dissection (SCAD)-caused AMIs occur when a hematoma in an arterial wall obstructs blood flow to the heart. SCAD-caused AMIs are more commonly found in young women, and are the leading cause of pregnancy-related heart attacks. Due to the limited availability of information surrounding management of this condition and an increased likelihood of hospital readmission and recurrence post SCAD-AMIs, it is thought that patients with SCAD may experience more stress than patients with typical AMIs. However, very few studies have specifically looked at the differences in stress and mental health between SCAD patients and typical AMI patients.
To address this gap in the literature, this study looked at two samples of patients with AMI – one group recruited from two hospitals in Melbourne, Australia, and a second group of patients recruited from the United States and Australia from cardiac rehab programs, general practices and through social media. Both groups were asked to complete a series of questionnaires related to anxiety, depression and distress, and sociodemographic and clinical questions. A total of 162 AMI patients responded to the questionnaire and, of that population, 35 had been diagnosed with SCAD and 127 had not been diagnosed with SCAD.
Results from the sociodemographic and clinical questions show that SCAD patients are much more likely to be female, younger than 60 and to have a university education than typical AMI patients. SCAD patients also showed differences in cardiovascular risk factors from the typical AMI patient – they tend to be more likely to report themselves as obese and are less likely to have high blood pressure, high cholesterol and diabetes.
After adjusting for confounding factors, it was found that patients with SCAD did show some significant elevation of results for specific anxiety, depression and distress measures compared to typical patients. The study adjusted for confounding factors, and while they found that there were not statistically significant differences between scores on the PHQ2, scores for SCAD patients on the GAQ2, K6 and CDI measures were significantly worse than typical AMI patients.
While the author group noted some limitations in their study, including the small sample size for SCAD patients and that the results of the questionnaires and medical history were self-reported, the results do indicate that SCAD patients are more likely to experience anxiety, distress and depression than typical AMI patients and should be provided with tailored support and resources to help their physical and emotional recovery while participating in cardiac rehab. The team also called for future studies to investigate which support and resource strategies will work best in aiding in recovery for this specific population.
To read the full study, access JCRP through the AACVPR Member Portal here and search for “Prevalence of Anxiety, Depression, and Distress in SCAD and Non-SCAD AMI Patients - A Comparative Study.”
A visual representation of the study results can also be viewed below in the form of a visual abstract from the author team:
Additional visual abstracts can be found on JCRP’s social media accounts on Facebook, Twitter and Instagram.