The Ontopsychological Psychotherapy in Patients with Acute Myocardial Infarction

the STEP-IN-AMI (Short TErm Psychotherapy IN Acute Myocardial Infarction) trial

Resumen

PURPOSE: This research was aimed to evaluate whether a short-term ontopsychological psychotherapy improves long-term clinical outcomes in patients with an acute myocardial infarction (AMI).

METHODS: Patients ≤70 years old were randomized within 1 week of their AMI to short-term ontopsychological psychotherapy plus routine medical therapy vs routine medical therapy alone. The primary composite outcome was defined as the combined incidence of new cardiovascular events (re-infarction, death, stroke, revascularization, life-threatening ventricular arrhythmias, and the recurrence of clinically significant angina) and clinically significant new comorbidities. Secondary outcome measures were: the rate of re-hospitalization for cardiovascular problems; New York Heart Association functional class; and psychometric tests scores.

RESULTS: Ninety-four patients were analyzed. The 2 treatment groups were similar across baseline characteristics. At 5-year follow-up, psychotherapy patients had a lower incidence of primary outcome, relative to controls (77/223 vs 98/202 patient-years, respectively; P = .035; absolute risk reduction = 19%, number needed to treat = 8); this benefit was mainly attributable to the lower incidence of new comorbidities and clinically significant angina in the psychotherapy group. Gains in the primary outcome, relative to controls, among psychotherapy patients occurred in the first year and subsequently remained stable over the following 4 years.

CONCLUSIONS: A short-term ontopsychological psychotherapy added to routine secondary prevention of myocardial infarction improves clinical outcomes at 1 years, and the results persist up to 5 years post AMI. Other larger studies remain necessary to confirm these results.

TRIAL REGISTRATION: www.ClinicalTrial.gov NCT00769366