Positive psychology differences and risk stratification between STEMI and NSTEMI
Authors: Moreno G , Magan I , Jurado-Barba R , Corral M , Bueno H 
Published: July 2022

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Spanish Society of Cardiology

Introduction
Clinical presentation of myocardial infarction (MI) is broad and can be differentiated into different risk groups based on electrocardiogram (ECG) presentation, ST-segment elevation MI (STEMI) or Non-ST-segment elevation MI (NSTEMI), with different in-hospital mortality rates and short-term mortality rates after discharge. Psychological variables also have an impact on post-MI prognosis. Factors such as stress, anxiety or depression have been associated with a higher cardiovascular risk and positive psychological variables, such as optimism, have has been related to a lower risk of cardiovascular mortality after MI. Patients may present different psychological profiles regarding the early ECG presentation which could be associated with differences in cardiovascular events and mortality.

Purpose
The aim of this study is to assess whether positive and negative psychological factors are associated with early ECG presentation. This is relevant as it could help refining risk stratification and improving secondary prevention, including psychological interventions.

Methods
93 patients admitted to a tertiary hospital with MI were divided into groups based on the early electrocardiogram presentation (STEMI vs. NSTEMI). Differences in sociodemographic, clinical history, lifestyle, coping styles, mental and physical quality of life, anxiety, depression, stress, optimism, positive and negative affect and psychological well-being were assessed using Chi-Square test and Student-t test. Psychological well-being was composed by the following dimensions: self-acceptance, positive relationships, autonomy, environmental domain, personal growth and purpose in life. If any difference emerged in the sociodemographic control variables (age and sex), the corresponding analyses of covariance (ANCOVAs) were performed.

Results
STEMI patients (n = 64) had a significantly lower mean age (p = 0.02), lower BMI (p = 0.03) and presented less previous heart failure (p = 0.03). Significantly lower levels of optimism (p = 0.03) compared to the NSTEMI group (n = 29) were observed, difference that showed a medium effect size magnitude (d = 0.48). ECG presentation explain 8% variance of levels of optimism and age explain 6% of the variability of dispositional optimism. STEMI patients also perceived a significant higher level of mental quality of life comparing to NSTEMI group (p = 0.05), difference that had a medium magnitude (d = 0.43). ECG presentation contribute in 5% to the variability of mental quality of life, but the age had no significant effect (p = 0.37). No differences were observed between groups in coping styles, anxiety, depression, stress, positive and negative affect and psychological well-being.

Conclusions
STEMI patients seem to have different psychological profile compared with NSTEMI. Particularly for optimism and mental quality of life. This may have future implications for psychological rehabilitation of patients with MI.