Brief psychological intervention in patients admitted after acute coronary syndrome: Essential or secondary?

Psychosocial factors have a significant effect on cardiovascular risk, to an extent that is comparable to that of hypertension or abdominal obesity. 1 Acute coronary syndromes (ACS) also trigger emotional reactions that can be severe, 2,3 and an acute cardiac event or unexpected admission to an intensive care unit can be frightening and stressful. 4Studies on individuals who have suffered myocardial infarction (MI) reveal high levels of depression and anxiety (31% and 26%, respectively, before discharge, 2 as well as one and two years afterwards 2,3 ).These figures are important because depression and anxiety are independent predictors of reinfarction, 5 due to a variety of pathophysiological mechanisms including hyperactivity of the sympathetic nervous system and of the hypothalamushypophysis-adrenal axis, alterations in platelet function, inflammation, and endothelial dysfunction. 6---8 Studies have shown a strong association between a major stressful event and the occurrence of MI and cardiac mortality.