Symptom experience during acute coronary syndrome and the development of posttraumatic stress symptoms Anna Wikman • Nadine Messerli-Bu ¨rgy • Gerard J. Molloy • Gemma Randall • Linda Perkins-Porras • Andrew Steptoe Received: May 5, 2011 / Accepted: June 29, 2011 / Published online: July 9, 2011 Ó Springer Science+Business Media, LLC 2011 Abstract There is growing evidence for the development of posttraumatic stress symptoms as a consequence of acute cardiac events. Acute coronary syndrome (ACS) patients experience a range of acute cardiac symptoms, and these may cluster together in specific patterns. The objectives of this study were to establish distinct symptom clusters in ACS patients, and to investigate whether the experience of different types of symptom clusters are associated with posttraumatic symptom intensity at six months. ACS patients were interviewed in hospital within 48 h of admission, 294 patients provided information on symptoms before hospitalisation, and cluster analysis was used to identify patterns. Posttraumatic stress symptoms were assessed in 156 patients at six months. Three symptom clusters were identified; pain symptoms, diffuse symptoms and symptoms of dyspnea. In multiple regression analyses, adjusting for sociodemographic, clinical and psychological factors, the pain symptoms cluster (b = .153, P = .044) emerged as a significant predictor of posttraumatic symp- tom severity at six months. A marginally significant asso- ciation was observed between symptoms of dyspnea and reduced intrusive symptoms at six months (b =-.156, P = .061). Findings suggest acute ACS symptoms occur in distinct clusters, which may have distinctive effects on intensity of subsequent posttraumatic symptoms. Since posttraumatic stress is associated with adverse outcomes, identifying patients at risk based on their symptom experi- ence during ACS may be useful in targeting interventions. Keywords Posttraumatic stress symptoms Á Acute coronary syndrome Á Cardiac symptoms Á Cluster analysis Introduction Acute coronary syndrome (ACS) patients experience a variety of symptoms on the onset of the coronary event. The term ‘acute coronary syndrome’ encompasses a spec- trum of acute coronary heart disease manifestations that includes ST-elevation myocardial infarction (STEMI), non ST-elevation myocardial infarction (NSTEMI), and unsta- ble angina (UA). Traditionally, chest pain has been seen as the primary indicator of ACS and many health-related texts and educational materials for the public focus on chest pain as the cardinal symptom (Canto et al., 2000). Yet, although chest pain is the most common symptom of ACS (Canto et al., 2000), patients experience a wide variety of other acute cardiac symptoms. The general public appears to be knowledgeable about the association of chest pain with ACS (Caldwell & Miaskowski, 2000; Goff et al., 1998; A. Wikman Á G. Randall Á A. Steptoe Department of Epidemiology and Public Health, University College London, London, UK A. Wikman (&) Department of Molecular Medicine and Surgery, Upper Gastrointestinal Research, Karolinska Institutet, Norra Stationsgatan 67, level 2, 171 76 Stockholm, Sweden e-mail: anna.wikman@ki.se N. Messerli-Bu ¨rgy Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland G. J. Molloy Department of Psychology, University of Stirling, Stirling, Scotland, UK L. Perkins-Porras Community Health Sciences, St Georges, University of London, London, UK 123 J Behav Med (2012) 35:420–430 DOI 10.1007/s10865-011-9369-x