Behavioral and physiologic determinants of long-term prognosis after myocardial infarction

We studied the accuracy of predictions of long-term prognosis after infarction in a sample of 118 non-smoking, post-coronary males using: behavioral indices only; physiologic risk factors only; and a combination of behavioral indices and physiologic risk factors. To isolate valid behavioral indices, we measured 49 signs and symptoms of a lifestyle characterized by chronic struggle from videotapes of subjects undergoing a structured interview. Of these, 15 had a univariate relationship to recurrent cardiac events, and four--intensity, self-involvement, periorbital pigmentation and arousal while driving--had a multivariate relationship. Of six physiologic risk factors, one--the Peel Index--was related to recurrent cardiac events. Separately, each model achieved approximately 70% accuracy in classifying subjects into their future reinfarction status; jointly, predictive accuracy increased to 75%. The results suggest that living a lifestyle of chronic struggle increases risk for recurrent myocardial infarction, independently of the risk incurred by standard physiologic risk factors. The need for precise assessment of individual signs and symptoms of this lifestyle and implications for secondary prevention are discussed.