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Short-term psychotherapy reduces CV events, comorbidities after acute MI

Stephen Padilla
11 Jun 2019

Administration of short-term ontopsychological psychotherapy in addition to contemporary routine medical treatment improves clinical outcomes throughout 5 years of follow-up after an acute myocardial infarction (AMI), results of the STEP-IN-AMI* trial have shown.

“The reduced incidence of new comorbidities could be due to a systemic effect of psychotherapy, because the psychotherapeutic intervention that was administered was a multilevel intervention with both single and group sessions, and entailed psychological and educational discussions, and body relaxation techniques,” researchers noted.

Patients aged ≤70 years (n=94; 425 patient-years) were randomly assigned within 1 week of their AMI to either short-term ontopsychological psychotherapy plus routine medical therapy or routine medical therapy only. Baseline characteristics were comparable between the two groups.

The primary outcome was the composite of new cardiovascular (CV) events (ie, reinfarction, death, stroke, revascularization, life-threatening ventricular arrhythmias and recurrence of clinically significant angina) and clinically significant new comorbidities. Secondary outcomes included rates for individual components of the primary outcome, rate of rehospitalization for CV problems and New York Association functional class.

Incidence of the primary outcome at 5-year follow-up was lower among psychotherapy patients than controls (77/223 vs 98/202 patient-years, respectively; p=0.035; absolute risk reduction, 19 percent; number needed to treat=8). This benefit was driven by the reduced rate of new comorbidities and clinically significant angina in the psychotherapy group. [Am J Med 2019;132:639-646.e5]

Improvements in the primary outcome among psychotherapy patients compared with controls occurred in the first year and subsequently remained stable over the following 4 years.

In a previous analysis of the STEP-IN-AMI trial, incidence of the primary composite outcome consisting of CV and non-CV events in the psychotherapy group after 1 year was significantly decreased. [Int J Cardiol 2013;170:132-139]

Multivariable analysis showed that only psychotherapy predicted the primary composite outcome in the long term, with odds for such outcomes reduced by 80 percent after controlling for confounders.

“These results identify a positive and independent effect of psychotherapy on long-term post-AMI outcomes and add to the preliminary 1-year results important new evidence demonstrating both the durability and stability of these advantages throughout 5 years of follow-up,” researchers said.

Two recent meta-analyses (n=9,000) found an association between psychotherapy and reduced morbidity in patients with ischaemic heart disease, but these studies were deemed to have low-quality evidence. [Cochrane Database Syst Rev 2017;2017:CD002902; Biondi-Zoccai, G, Mazza, M, Roever, L, van Dixhoorn, J, Frati, G, and Abbate, A. In: A Roncella, C Pristipino (Eds.) Psychotherapy for Ischemic Heart Disease. An Evidence-Based Clinical Approach. Springer International Publishing: Cham 2016]

“Larger trials remain necessary to confirm our results and to identify possible further psychotherapeutic strategies in post-MI patients, given the time trends observed in this study, which could further improve patients’ prognosis long term,” researchers noted.

*Short-TErm Psychotherapy IN Acute Myocardial Infarction

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Roshini Claire Anthony, 11 Sep 2019

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