Anxiety, independent of depressive symptoms, is associated with in-hospital cardiac complications after acute myocardial infarction

Objective: Post-myocardial infarction (MI) anxiety, independent of demographic and medical variables, has been linked to in-hospital cardiac complications in prior studies, but such studies have not included a concomitant assessment of depressive symptoms. The aim of this exploratory study was to determine whether post-MI anxiety was associated with in-hospital cardiac complications, independent of depressive symptoms. Methods: Subjects within 72 hours of acute MI (n=110) were prospectively assessed for anxiety [using the Beck Anxiety Inventory (BAI)] and depressive symptoms (using the Beck Depression Inventory-II and structured interview diagnoses of major depressive disorder). Individual in-hospital complications and pooled serious cardiac complications (defined as recurrent ischemia, reinfarction, congestive heart failure, and ventricular arrhythmia requiring intervention) were recorded via chart review. Results: On hierarchical multiple logistic regression analysis that accounted for demographic variables, cardiac illness, and depressive symptoms, post-MI anxiety was significantly associated with pooled serious in-hospital cardiac complications (P=.003). In addition, when the anxiety measure was limited to only the psychological symptoms of anxiety (BAI-P), post-MI anxiety remained an independent predictor of cardiac complications (P=.015). Conclusions: These findings suggest that the association of post-MI anxiety with in-hospital cardiac complications exists above and beyond the effects of depression. Larger studies are needed to confirm these findings, and treatment studies are needed to determine the impact of anxiety treatment on in-hospital cardiac outcomes. (C) 2008 Elsevier Inc. All rights reserved.