Prospective association between anxiety and depression trajectories and major adverse cardiovascular events in patients with acute coronary syndrome

Purpose This study aims to identify heterogeneous trajectories of anxiety and depression among patients with acute coronary syndrome (ACS) and to examine the prospective associations between these trajectories and subsequent major adverse cardiovascular events (MACEs). Methods A longitudinal design was employed. From September 2022 to January 2024, 559 patients with ACS were recruited from the cardiology department of a tertiary hospital. Anxiety and depressive symptoms were assessed using the Hospital Anxiety and Depression Scale at four time points: baseline, 3–4 months, 6–7 months, and 9–10 months post-onset. MACEs were documented within one year after completion of the emotional follow-up. Growth mixture modeling was used to identify heterogeneous trajectories of anxiety and depression, and binary logistic regression was applied to examine the associations between trajectory membership and MACEs. Results Two distinct trajectories were identified for anxiety: low-onset-remission (89.9%) and high-onset-persistent (10.1%). Similarly, depression exhibited two trajectories: low-onset-persistent (74.1%) and high-onset-worsening (25.9%). After adjusting for sociodemographic and clinical characteristics, high-onset-persistent anxiety (OR = 5.136, 95% CI: 2.554–10.329) and high-onset-worsening depression (OR = 1.880, 95% CI: 1.154–3.062) emerged as independent risk factors for MACEs. Conclusion ACS patients exhibit heterogeneous longitudinal patterns of anxiety and depression, with high-onset-persistent anxiety and high-onset-worsening depression independently associated with elevated MACE risk. These findings underscore the prognostic limitations of single-time-point psychological screening and highlight the potential value of dynamic monitoring for identifying patients who may benefit from targeted psychological interventions.