BACKGROUND Key dimensions of cardiac arrest-induced posttraumatic stress disorder (PTSD) symptoms include reexperiencing, avoidance, numbing, and hyperarousal. It remains unknown which dimensions are most predictive of outcome. PURPOSE To determine which dimensions of cardiac arrest-induced PTSD are predictive of clinical outcome within 13 months posthospital discharge. METHODS PTSD symptoms were assessed in survivors of cardiac arrest who were able to complete psychological screening measures at hospital discharge via the PTSD Checklist-Specific scale, which queries for 17 symptoms using five levels of severity. Responses on items for each symptom dimension of the four-factor numbing model (reexperiencing, avoidance, numbing, and hyperarousal) were converted to Z-scores and treated as continuous predictors. The combined primary endpoint was all-cause mortality (ACM) or major adverse cardiovascular events (MACE; hospitalization for myocardial infarction, unstable angina, heart failure, emergency coronary revascularization, or urgent defibrillator/pacemaker placements) within 13 months postdischarge. Four bivariate Cox proportional hazards survival models evaluated associations between individual symptom dimensions and ACM/MACE. A multivariable model then evaluated whether significant bivariate predictors remained independent predictors of the primary outcome after adjusting for age, sex, comorbidities, premorbid psychiatric diagnoses, and initial cardiac rhythm. RESULTS A total of 114 patients (59.6% men, 52.6% white, mean age: 54.6 ± 13 years) were included. In bivariate analyses, only hyperarousal was significantly associated with ACM/MACE. In a fully adjusted model, 1 standard deviation increase in hyperarousal symptoms corresponded to a two-times increased risk of experiencing ACM/MACE. CONCLUSIONS Greater level of hyperarousal symptoms was associated with a higher risk of ACM/MACE within 13 months postcardiac arrest. This initial evidence should be further investigated in a larger sample.

中文翻译：

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心脏骤停幸存者的过度刺激症状与重大不良心血管事件和全因死亡率的13个月风险相关。

背景技术心脏骤停引起的创伤后应激障碍（PTSD）症状的关键维度包括重新体验，避免，麻木和过度兴奋。尚不清楚哪个维度最能预测结果。目的确定在医院出院后13个月内哪些心搏停止诱发的PTSD可以预测临床结果。方法对能够在出院时完成心理筛查措施的心脏骤停幸存者进行PTSD症状评估，该量表通过PTSD清单特定量表进行评估，该量表使用五个严重程度来查询17种症状。对于四因素麻木模型的每个症状维度（重新体验，回避，麻木和过度情绪）对项目的响应被转换为Z评分，并被视为连续的预测指标。合并的主要终点是出院后13个月内的全因死亡率（ACM）或主要不良心血管事件（MACE；住院治疗的心肌梗死，不稳定型心绞痛，心力衰竭，紧急冠脉重建或紧急除颤器/起搏器放置）。四个双变量Cox比例风险生存模型评估了个体症状大小与ACM / MACE之间的关联。然后，在对年龄，性别，合并症，病前精神病学诊断和初始心律进行调整后，多变量模型评估了重要的双变量预测因子是否仍是主要预后的独立预测因子。结果共纳入114例患者（男性59.6％，白人52.6％，平均年龄：54.6±13岁）。在双变量分析中，只有过度刺激与ACM / MACE显着相关。在完全调整的模型中，超躁狂症状的标准差增加1倍，相当于经历ACM / MACE的风险增加2倍。结论较高的耳鸣症状与在明信片停滞后13个月内发生ACM / MACE的较高风险有关。此初始证据应在更大的样本中进一步研究。