SPC365

The perceived stress in acute coronary syndrome patients

Session: Posters - E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Speaker: Margarida G. Figueiredo

Congress: CPC 2021
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.1 Acute Coronary Syndromes – Pathophysiology and Mechanisms
Session Type: Posters
FP Number: ---
Authors: Margarida G Figueiredo; Hélder Santos; Mariana Santos; Paula Sofia Paula; Inês Gracio Almeida; Micaela Neto; Catarina sá; Samuel Almeida; Joana Chin; Catarina Sousa; Lurdes Almeida
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:'Times New Roman'"><span style="color:#000000"><strong>Aims:</strong></span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman'"><span style="color:#000000"> A complex physiopathological process with an interaction between several dynamic factors that maybe influence the Acute Coronary Syndrome (ACS). Some authors supporter that stress is a serious risk factor in ACS. The Perceived Stress Scale (PSS-10) is one of the most useful and validate instruments to estimate the perceived stress.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:'Times New Roman'"><span style="color:#000000"><strong>Methods:</strong></span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman'"><span style="color:#000000"> Single-centre prospective study, engaging patients hospitalized with ACS between 20/03/2019-31/03/2020. All patients completed the PSS-10 during their hospitalization period. PSS-10 was validated in the Portuguese population by Trigo, </span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman'"><span style="color:#000000"><em>et al</em></span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman'"><span style="color:#000000">, with 10 questions and 5 possible answers in which each question was punctuated between 0 and 4 (maximum 40 points), allowing us to estimate the level of stress in the context of physical disease. The pathological stress level was established in the Portuguese population as &gt;20 points in males and &gt;22 points in females. T-student tests were used to compare categorical and continuous variables between groups and the Portuguese population. Multiple linear regression was used to establish the relation between the variables and the stress levels.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:'Times New Roman'"><span style="color:#000000"><strong>Results:</strong></span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman'"><span style="color:#000000"> 171 patients with ACS were included, 36.5% presented ST-Elevation Myocardial Infarction (STEMI), 38.1% of the ACS were females and the mean PSS punctuation of 19.5 &plusmn; 7.1. 70 patients presented a level of stress considered pathologic in the Portuguese population&nbsp;according to Trigo</span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman'"><span style="color:#000000"><em>, et al </em></span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman'"><span style="color:#000000">(5) publication. Patients with pathologic stress scored 26.16 &plusmn; 3.76 points in the PSS-10&nbsp;comparing to 14.43 &plusmn; 4.23 points in the general population, </span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman'"><span style="color:#000000"><em>p</em></span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman'"><span style="color:#000000">&lt;0.001. Pathologic stress patients presented lower weight (73.52 &plusmn; 12.32 vs 77.09 &plusmn; 14.13, </span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman'"><span style="color:#000000"><em>p</em></span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman'"><span style="color:#000000">=0.035) and lower rates of normal coronary angiography (24.71% vs 29.41%, </span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman'"><span style="color:#000000"><em>p</em></span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman'"><span style="color:#000000">=0.050). No differences between groups were detected regarding age, sex, STEMI as ACS presentation, cardiovascular conditions and other comorbidities, admission clinical vital signs, admission blood analysis parameters, left ventricular ejection fraction (LVEF), MACE and hospitalization time. None of the variables was a predictor of pathologic stress. All the patients that completed the PSS-10 were discharged and no deaths were registered in our population during the hospitalization time. The presence of higher stress levels on the PSS-10 was not associated with severity at admission, namely with Killip-Kimball class at admission. Stress levels on the PSS-10 were a good predictor of ACS presentation as STEMI, R</span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman'"><span style="color:#000000"><sup>2</sup></span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman'"><span style="color:#000000"> 0.41, p=0.014 [odds ratio (OR): 1.006, p=0.016, confidence interval (CI) 1.0001-1.011]. PSS-10 stress levels were not a predictor of MACE, nevertheless, they were capable to predict stroke occurrence during the hospitalization for ACS with an R</span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman'"><span style="color:#000000"><sup>2</sup></span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman'"><span style="color:#000000"> 0.42, p=0.011.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:'Times New Roman'"><span style="color:#000000"><strong>Conclusions:</strong></span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman'"><span style="color:#000000"> Using real-life data, perceived stress should be considered a prognostic marker&nbsp;since has proved to be a predictor of STEMI presentation as well of stroke complication on ACS patients.</span></span></span></p>