Role of interactions between psychological and clinical factors in determining 6-month mortality among patients with acute myocardial infarction: Application of recursive partitioning techniques to the GISSI-2 database

F. Carinci, A. Nicolucci, A. Ciampi, D. Labbrozzi, O. Bettinardi, A. M. Zotti, G. Tognoni, G. A. Feruglio, A. Lotto, F. Rovelli, P. Solinas, L. Tavazzi, C. De Vita, M. G. Franzosi, A. P. Maggioni, F. Mauri, A. Volpi, A. Selvini, L. Donato, S. GarattiniU. Loi, G. Sirchia, G. Mezzanotte, E. Santoro, F. Giordano, R. Barlotti, G. Loparco, S. Boscarino, G. Ruggeri, R. Anastasi, E. Paciaroni, P. F. Tomassini, A. Purcaro, M. Francesconi, S. Figliolia, S. Tesse, G. Devoti, R. Giorntti, P. Tenoni, A. Burali, S. Amabili, C. A. Caratti, G. Zola, P. Ferraguto, G. Salici, D. Rotiroti, M. Genovese, N. D'Amato, L. Taurino, D. Messina, G. Sarcina, R. Malacrida, C. Gradel, A. Bridda, P. Pellegrini, L. Acone, A. Bruno, F. Bobba, D. Torta, G. Scaramuzzino, C. Berardi, W. Lintner, A. Erlicher, W. Pitscheider, R. Scola Gagliardi, G. Bonizzato, C. Roggero, A. Perrini, A. Storelli, A. Verrienti, A. Albonico, L. Corradi, V. De Petra, B. Villani, P. Maxia, A. Bianco, E. Crabu, F. Vancheri, C. Amico, G. Santopuoli, F. Baldini, C. Aletto, G. Gozzelino, G. Pettinati, F. De Santis, E. Correale, S. Romano, R. Perrotta, C. Tritto, L. May, G. Achilli, G. Suzzi, C. Cernetti, R. Longobardi, G. Somma, P. Gallone, C. Palumbo, F. Sorrentino, A. Dato

Research output: Contribution to journalArticle

Abstract

Background. Clinical and epidemiological studies support the hypothesis that ischaemic cardiovascular diseases are consistently associated with psychological, social and behavioural factors. Nevertheless, the joint effect of clinical characteristics and psychological variables in determining the prognosis of acute myocardial infarction survivors has been seldom investigated. Methods and Results. In the framework of the GISSI-2 trial, the impact of psychological factors on 6-month mortality and their interaction with clinical features was included as an ad hoc research project. Overall, 2449 patients were evaluated, 63 of whom died during the study period. All patients undertook a self-administered questionnaire (Cognitive Behavioural Assessment Hospital Form), investigating 16 psychological dimensions relative to three areas (state variables, vital exhaustion, trait variables). The impact of psychological variables on prognosis and their interaction with clinical variables were investigated by using a tree-growing technique (RECursive Partitioning and AMalgamation - RECPAM) applied to survival analysis. This statistical method allowed the identification of three separate classes, characterized by different prognoses: Class I (presence of vital exhaustion), Class II (concomitance of no vital exhaustion, depression and low levels of anxiety) and Class III (all other patients). After adjusting for the clinical variables, Class I was associated with an intermediate prognosis (hazard ratio [HR] = 2.2; 95% confidence intervals [CI]: 1.2-4.0) and Class II to the worst (HR = 3.2; 95% CI = 1.6-6.2), as compared to Class III. High levels of neuroticism and extroversion were associated with a better prognosis. When clinical and psychological variables were simultaneously investigated by RECPAM, Type A behaviour was shown to be an important risk predictor among patients with better clinical conditions, i.e. those eligible for exercise test (HR = 2.6, 95% CI= 1.2-5.5). Finally, a striking difference in the impact of the most predictive clinical variables (exercise test ineligibility, late and early ventricular failure) was found among patients with and without vital exhaustion. Conclusions. This study shows that acute myocardial infarction survivors are heterogeneous with respect to 6-month mortality according to their psychological profile. More important, the impact of these variables appears comparable to that of very well known clinical risk predictors. The availability of a large study population, together with the use of innovative statistical techniques, allowed us to identify subgroups of patients for whom the joint action of clinical and psychological characteristics has been clearly documented. This suggests the need for incorporating psychological evaluation in the care of acute myocardial infarction patients.

Original languageEnglish
Pages (from-to)835-845
Number of pages11
JournalEuropean Heart Journal
Volume18
Issue number5
Publication statusPublished - 1997

Fingerprint

Myocardial Infarction
Databases
Psychology
Mortality
Confidence Intervals
Exercise Test
Survivors
Survival Analysis
Epidemiologic Studies
Cardiovascular Diseases
Anxiety
Depression
Research
Population

Keywords

  • Mortality
  • Myocardial infarction
  • Psychological characteristics
  • Recursive partitioning

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Role of interactions between psychological and clinical factors in determining 6-month mortality among patients with acute myocardial infarction : Application of recursive partitioning techniques to the GISSI-2 database. / Carinci, F.; Nicolucci, A.; Ciampi, A.; Labbrozzi, D.; Bettinardi, O.; Zotti, A. M.; Tognoni, G.; Feruglio, G. A.; Lotto, A.; Rovelli, F.; Solinas, P.; Tavazzi, L.; De Vita, C.; Franzosi, M. G.; Maggioni, A. P.; Mauri, F.; Volpi, A.; Selvini, A.; Donato, L.; Garattini, S.; Loi, U.; Sirchia, G.; Mezzanotte, G.; Santoro, E.; Giordano, F.; Barlotti, R.; Loparco, G.; Boscarino, S.; Ruggeri, G.; Anastasi, R.; Paciaroni, E.; Tomassini, P. F.; Purcaro, A.; Francesconi, M.; Figliolia, S.; Tesse, S.; Devoti, G.; Giorntti, R.; Tenoni, P.; Burali, A.; Amabili, S.; Caratti, C. A.; Zola, G.; Ferraguto, P.; Salici, G.; Rotiroti, D.; Genovese, M.; D'Amato, N.; Taurino, L.; Messina, D.; Sarcina, G.; Malacrida, R.; Gradel, C.; Bridda, A.; Pellegrini, P.; Acone, L.; Bruno, A.; Bobba, F.; Torta, D.; Scaramuzzino, G.; Berardi, C.; Lintner, W.; Erlicher, A.; Pitscheider, W.; Scola Gagliardi, R.; Bonizzato, G.; Roggero, C.; Perrini, A.; Storelli, A.; Verrienti, A.; Albonico, A.; Corradi, L.; De Petra, V.; Villani, B.; Maxia, P.; Bianco, A.; Crabu, E.; Vancheri, F.; Amico, C.; Santopuoli, G.; Baldini, F.; Aletto, C.; Gozzelino, G.; Pettinati, G.; De Santis, F.; Correale, E.; Romano, S.; Perrotta, R.; Tritto, C.; May, L.; Achilli, G.; Suzzi, G.; Cernetti, C.; Longobardi, R.; Somma, G.; Gallone, P.; Palumbo, C.; Sorrentino, F.; Dato, A.

In: European Heart Journal, Vol. 18, No. 5, 1997, p. 835-845.

Research output: Contribution to journalArticle

Carinci, F, Nicolucci, A, Ciampi, A, Labbrozzi, D, Bettinardi, O, Zotti, AM, Tognoni, G, Feruglio, GA, Lotto, A, Rovelli, F, Solinas, P, Tavazzi, L, De Vita, C, Franzosi, MG, Maggioni, AP, Mauri, F, Volpi, A, Selvini, A, Donato, L, Garattini, S, Loi, U, Sirchia, G, Mezzanotte, G, Santoro, E, Giordano, F, Barlotti, R, Loparco, G, Boscarino, S, Ruggeri, G, Anastasi, R, Paciaroni, E, Tomassini, PF, Purcaro, A, Francesconi, M, Figliolia, S, Tesse, S, Devoti, G, Giorntti, R, Tenoni, P, Burali, A, Amabili, S, Caratti, CA, Zola, G, Ferraguto, P, Salici, G, Rotiroti, D, Genovese, M, D'Amato, N, Taurino, L, Messina, D, Sarcina, G, Malacrida, R, Gradel, C, Bridda, A, Pellegrini, P, Acone, L, Bruno, A, Bobba, F, Torta, D, Scaramuzzino, G, Berardi, C, Lintner, W, Erlicher, A, Pitscheider, W, Scola Gagliardi, R, Bonizzato, G, Roggero, C, Perrini, A, Storelli, A, Verrienti, A, Albonico, A, Corradi, L, De Petra, V, Villani, B, Maxia, P, Bianco, A, Crabu, E, Vancheri, F, Amico, C, Santopuoli, G, Baldini, F, Aletto, C, Gozzelino, G, Pettinati, G, De Santis, F, Correale, E, Romano, S, Perrotta, R, Tritto, C, May, L, Achilli, G, Suzzi, G, Cernetti, C, Longobardi, R, Somma, G, Gallone, P, Palumbo, C, Sorrentino, F & Dato, A 1997, 'Role of interactions between psychological and clinical factors in determining 6-month mortality among patients with acute myocardial infarction: Application of recursive partitioning techniques to the GISSI-2 database', European Heart Journal, vol. 18, no. 5, pp. 835-845.
Carinci, F. ; Nicolucci, A. ; Ciampi, A. ; Labbrozzi, D. ; Bettinardi, O. ; Zotti, A. M. ; Tognoni, G. ; Feruglio, G. A. ; Lotto, A. ; Rovelli, F. ; Solinas, P. ; Tavazzi, L. ; De Vita, C. ; Franzosi, M. G. ; Maggioni, A. P. ; Mauri, F. ; Volpi, A. ; Selvini, A. ; Donato, L. ; Garattini, S. ; Loi, U. ; Sirchia, G. ; Mezzanotte, G. ; Santoro, E. ; Giordano, F. ; Barlotti, R. ; Loparco, G. ; Boscarino, S. ; Ruggeri, G. ; Anastasi, R. ; Paciaroni, E. ; Tomassini, P. F. ; Purcaro, A. ; Francesconi, M. ; Figliolia, S. ; Tesse, S. ; Devoti, G. ; Giorntti, R. ; Tenoni, P. ; Burali, A. ; Amabili, S. ; Caratti, C. A. ; Zola, G. ; Ferraguto, P. ; Salici, G. ; Rotiroti, D. ; Genovese, M. ; D'Amato, N. ; Taurino, L. ; Messina, D. ; Sarcina, G. ; Malacrida, R. ; Gradel, C. ; Bridda, A. ; Pellegrini, P. ; Acone, L. ; Bruno, A. ; Bobba, F. ; Torta, D. ; Scaramuzzino, G. ; Berardi, C. ; Lintner, W. ; Erlicher, A. ; Pitscheider, W. ; Scola Gagliardi, R. ; Bonizzato, G. ; Roggero, C. ; Perrini, A. ; Storelli, A. ; Verrienti, A. ; Albonico, A. ; Corradi, L. ; De Petra, V. ; Villani, B. ; Maxia, P. ; Bianco, A. ; Crabu, E. ; Vancheri, F. ; Amico, C. ; Santopuoli, G. ; Baldini, F. ; Aletto, C. ; Gozzelino, G. ; Pettinati, G. ; De Santis, F. ; Correale, E. ; Romano, S. ; Perrotta, R. ; Tritto, C. ; May, L. ; Achilli, G. ; Suzzi, G. ; Cernetti, C. ; Longobardi, R. ; Somma, G. ; Gallone, P. ; Palumbo, C. ; Sorrentino, F. ; Dato, A. / Role of interactions between psychological and clinical factors in determining 6-month mortality among patients with acute myocardial infarction : Application of recursive partitioning techniques to the GISSI-2 database. In: European Heart Journal. 1997 ; Vol. 18, No. 5. pp. 835-845.
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abstract = "Background. Clinical and epidemiological studies support the hypothesis that ischaemic cardiovascular diseases are consistently associated with psychological, social and behavioural factors. Nevertheless, the joint effect of clinical characteristics and psychological variables in determining the prognosis of acute myocardial infarction survivors has been seldom investigated. Methods and Results. In the framework of the GISSI-2 trial, the impact of psychological factors on 6-month mortality and their interaction with clinical features was included as an ad hoc research project. Overall, 2449 patients were evaluated, 63 of whom died during the study period. All patients undertook a self-administered questionnaire (Cognitive Behavioural Assessment Hospital Form), investigating 16 psychological dimensions relative to three areas (state variables, vital exhaustion, trait variables). The impact of psychological variables on prognosis and their interaction with clinical variables were investigated by using a tree-growing technique (RECursive Partitioning and AMalgamation - RECPAM) applied to survival analysis. This statistical method allowed the identification of three separate classes, characterized by different prognoses: Class I (presence of vital exhaustion), Class II (concomitance of no vital exhaustion, depression and low levels of anxiety) and Class III (all other patients). After adjusting for the clinical variables, Class I was associated with an intermediate prognosis (hazard ratio [HR] = 2.2; 95{\%} confidence intervals [CI]: 1.2-4.0) and Class II to the worst (HR = 3.2; 95{\%} CI = 1.6-6.2), as compared to Class III. High levels of neuroticism and extroversion were associated with a better prognosis. When clinical and psychological variables were simultaneously investigated by RECPAM, Type A behaviour was shown to be an important risk predictor among patients with better clinical conditions, i.e. those eligible for exercise test (HR = 2.6, 95{\%} CI= 1.2-5.5). Finally, a striking difference in the impact of the most predictive clinical variables (exercise test ineligibility, late and early ventricular failure) was found among patients with and without vital exhaustion. Conclusions. This study shows that acute myocardial infarction survivors are heterogeneous with respect to 6-month mortality according to their psychological profile. More important, the impact of these variables appears comparable to that of very well known clinical risk predictors. The availability of a large study population, together with the use of innovative statistical techniques, allowed us to identify subgroups of patients for whom the joint action of clinical and psychological characteristics has been clearly documented. This suggests the need for incorporating psychological evaluation in the care of acute myocardial infarction patients.",
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language = "English",
volume = "18",
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journal = "European Heart Journal",
issn = "0195-668X",
publisher = "Oxford University Press",
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TY - JOUR

T1 - Role of interactions between psychological and clinical factors in determining 6-month mortality among patients with acute myocardial infarction

T2 - Application of recursive partitioning techniques to the GISSI-2 database

AU - Carinci, F.

AU - Nicolucci, A.

AU - Ciampi, A.

AU - Labbrozzi, D.

AU - Bettinardi, O.

AU - Zotti, A. M.

AU - Tognoni, G.

AU - Feruglio, G. A.

AU - Lotto, A.

AU - Rovelli, F.

AU - Solinas, P.

AU - Tavazzi, L.

AU - De Vita, C.

AU - Franzosi, M. G.

AU - Maggioni, A. P.

AU - Mauri, F.

AU - Volpi, A.

AU - Selvini, A.

AU - Donato, L.

AU - Garattini, S.

AU - Loi, U.

AU - Sirchia, G.

AU - Mezzanotte, G.

AU - Santoro, E.

AU - Giordano, F.

AU - Barlotti, R.

AU - Loparco, G.

AU - Boscarino, S.

AU - Ruggeri, G.

AU - Anastasi, R.

AU - Paciaroni, E.

AU - Tomassini, P. F.

AU - Purcaro, A.

AU - Francesconi, M.

AU - Figliolia, S.

AU - Tesse, S.

AU - Devoti, G.

AU - Giorntti, R.

AU - Tenoni, P.

AU - Burali, A.

AU - Amabili, S.

AU - Caratti, C. A.

AU - Zola, G.

AU - Ferraguto, P.

AU - Salici, G.

AU - Rotiroti, D.

AU - Genovese, M.

AU - D'Amato, N.

AU - Taurino, L.

AU - Messina, D.

AU - Sarcina, G.

AU - Malacrida, R.

AU - Gradel, C.

AU - Bridda, A.

AU - Pellegrini, P.

AU - Acone, L.

AU - Bruno, A.

AU - Bobba, F.

AU - Torta, D.

AU - Scaramuzzino, G.

AU - Berardi, C.

AU - Lintner, W.

AU - Erlicher, A.

AU - Pitscheider, W.

AU - Scola Gagliardi, R.

AU - Bonizzato, G.

AU - Roggero, C.

AU - Perrini, A.

AU - Storelli, A.

AU - Verrienti, A.

AU - Albonico, A.

AU - Corradi, L.

AU - De Petra, V.

AU - Villani, B.

AU - Maxia, P.

AU - Bianco, A.

AU - Crabu, E.

AU - Vancheri, F.

AU - Amico, C.

AU - Santopuoli, G.

AU - Baldini, F.

AU - Aletto, C.

AU - Gozzelino, G.

AU - Pettinati, G.

AU - De Santis, F.

AU - Correale, E.

AU - Romano, S.

AU - Perrotta, R.

AU - Tritto, C.

AU - May, L.

AU - Achilli, G.

AU - Suzzi, G.

AU - Cernetti, C.

AU - Longobardi, R.

AU - Somma, G.

AU - Gallone, P.

AU - Palumbo, C.

AU - Sorrentino, F.

AU - Dato, A.

PY - 1997

Y1 - 1997

N2 - Background. Clinical and epidemiological studies support the hypothesis that ischaemic cardiovascular diseases are consistently associated with psychological, social and behavioural factors. Nevertheless, the joint effect of clinical characteristics and psychological variables in determining the prognosis of acute myocardial infarction survivors has been seldom investigated. Methods and Results. In the framework of the GISSI-2 trial, the impact of psychological factors on 6-month mortality and their interaction with clinical features was included as an ad hoc research project. Overall, 2449 patients were evaluated, 63 of whom died during the study period. All patients undertook a self-administered questionnaire (Cognitive Behavioural Assessment Hospital Form), investigating 16 psychological dimensions relative to three areas (state variables, vital exhaustion, trait variables). The impact of psychological variables on prognosis and their interaction with clinical variables were investigated by using a tree-growing technique (RECursive Partitioning and AMalgamation - RECPAM) applied to survival analysis. This statistical method allowed the identification of three separate classes, characterized by different prognoses: Class I (presence of vital exhaustion), Class II (concomitance of no vital exhaustion, depression and low levels of anxiety) and Class III (all other patients). After adjusting for the clinical variables, Class I was associated with an intermediate prognosis (hazard ratio [HR] = 2.2; 95% confidence intervals [CI]: 1.2-4.0) and Class II to the worst (HR = 3.2; 95% CI = 1.6-6.2), as compared to Class III. High levels of neuroticism and extroversion were associated with a better prognosis. When clinical and psychological variables were simultaneously investigated by RECPAM, Type A behaviour was shown to be an important risk predictor among patients with better clinical conditions, i.e. those eligible for exercise test (HR = 2.6, 95% CI= 1.2-5.5). Finally, a striking difference in the impact of the most predictive clinical variables (exercise test ineligibility, late and early ventricular failure) was found among patients with and without vital exhaustion. Conclusions. This study shows that acute myocardial infarction survivors are heterogeneous with respect to 6-month mortality according to their psychological profile. More important, the impact of these variables appears comparable to that of very well known clinical risk predictors. The availability of a large study population, together with the use of innovative statistical techniques, allowed us to identify subgroups of patients for whom the joint action of clinical and psychological characteristics has been clearly documented. This suggests the need for incorporating psychological evaluation in the care of acute myocardial infarction patients.

AB - Background. Clinical and epidemiological studies support the hypothesis that ischaemic cardiovascular diseases are consistently associated with psychological, social and behavioural factors. Nevertheless, the joint effect of clinical characteristics and psychological variables in determining the prognosis of acute myocardial infarction survivors has been seldom investigated. Methods and Results. In the framework of the GISSI-2 trial, the impact of psychological factors on 6-month mortality and their interaction with clinical features was included as an ad hoc research project. Overall, 2449 patients were evaluated, 63 of whom died during the study period. All patients undertook a self-administered questionnaire (Cognitive Behavioural Assessment Hospital Form), investigating 16 psychological dimensions relative to three areas (state variables, vital exhaustion, trait variables). The impact of psychological variables on prognosis and their interaction with clinical variables were investigated by using a tree-growing technique (RECursive Partitioning and AMalgamation - RECPAM) applied to survival analysis. This statistical method allowed the identification of three separate classes, characterized by different prognoses: Class I (presence of vital exhaustion), Class II (concomitance of no vital exhaustion, depression and low levels of anxiety) and Class III (all other patients). After adjusting for the clinical variables, Class I was associated with an intermediate prognosis (hazard ratio [HR] = 2.2; 95% confidence intervals [CI]: 1.2-4.0) and Class II to the worst (HR = 3.2; 95% CI = 1.6-6.2), as compared to Class III. High levels of neuroticism and extroversion were associated with a better prognosis. When clinical and psychological variables were simultaneously investigated by RECPAM, Type A behaviour was shown to be an important risk predictor among patients with better clinical conditions, i.e. those eligible for exercise test (HR = 2.6, 95% CI= 1.2-5.5). Finally, a striking difference in the impact of the most predictive clinical variables (exercise test ineligibility, late and early ventricular failure) was found among patients with and without vital exhaustion. Conclusions. This study shows that acute myocardial infarction survivors are heterogeneous with respect to 6-month mortality according to their psychological profile. More important, the impact of these variables appears comparable to that of very well known clinical risk predictors. The availability of a large study population, together with the use of innovative statistical techniques, allowed us to identify subgroups of patients for whom the joint action of clinical and psychological characteristics has been clearly documented. This suggests the need for incorporating psychological evaluation in the care of acute myocardial infarction patients.

KW - Mortality

KW - Myocardial infarction

KW - Psychological characteristics

KW - Recursive partitioning

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C2 - 9152654

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VL - 18

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EP - 845

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

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