1. Patients with acute coronary symptoms exposed to benzodiazepines had four-fold relative risk of developing posttraumatic stress disorder, adjusting for symptoms of acute stress disorder.
Evidence Rating Level: 2 (Good)
Morphine and benzodiazepines are often provided during acute coronary syndromes (ACSs) for pain and anxiety, with beta-blockers also serving to reduce pain. However, benzodiazepines are known to increase the risk of posttraumatic stress symptoms (PTSS) during other traumas, suggesting that they may act similarly in ACS. This retrospective cohort study recruited 154 participants (M [SD] age = 58.7 [10.9] years, 15.6% female) from the Myocardial Infarction-Stress Prevention Intervention (MI-SPRINT) randomized controlled trial with a verified ACS, extracting baseline demographic, clinical, and psychological variables from patient records. Posttraumatic stress symptoms were assessed via the Clinician-Administered PTSD Scale (CAPS). PTSS were assessed three months following ACS. Approximately 37.7% of patients were exposed to benzodiazepines during ACS, while 72.1% were exposed to morphine and 88.3% to beta-blockers. Only 7.1% were provided antidepressant medication. Of the 154 participants, 11.7% (18) participants developed PTSD. Benzodiazepine use was significantly associated with CAPS total severity score after adjusting for all covariates (unstandardized coefficient B [SE] = 0.589 [0.274]; partial r = 0.18, p = 0.032). Benzodiazepine use was also associated with the re-experiencing score of the CAPS, which includes nightmares (B [SD] = 0.433 [0.217]; partial r = 0.17, p = 0.047). Those who were exposed to benzodiazepines demonstrated nearly four-times greater relative risk of developing PTSD, adjusting for symptoms of acute stress disorder (OR = 3.75, 95% CI 1.31 to 10.77). No predictive value was yielded from morphine, beta-blockers, or antidepressants. Overall, this study suggests that benzodiazepines, while effective in the short-term, may increase the risk of developing PTSD and related symptoms in those with ACS.
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