Dimensional structure and correlates of posttraumatic stress symptoms following suspected acute coronary syndrome

•PTSD symptoms induced by acute coronary syndrome (ACS) are common (12% prevalence).•We evaluated the dimensional structure of PTSD after suspected ACS.•A 4-factor dysphoria model with specific and non-specific PTSD symptoms fit best.•There was evidence of measurement invariance of this model by sex.•PTSD dimensions related differentially to perceived threat and aspirin adherence.

BackgroundPosttraumatic stress disorder (PTSD) is a heterogeneous construct, and some have suggested that PTSD triggered by acute coronary syndrome (ACS) may differ from PTSD due to prototypical traumas.MethodsWe conducted the first examination of the latent structure of PTSD symptoms after suspected ACS in 399 adults in the REactions to Acute Care and Hospitalization (REACH) study, an observational cohort study of patients recruited from the emergency department during evaluation for ACS. Using confirmatory factor analysis, we compared the 4-factor dysphoria, 4-factor numbing, and 5-factor dysphoric arousal models of PTSD.ResultsAlthough all models fit well, the dysphoria model was selected as the best-fitting model. Further, there was measurement invariance of the dysphoria model by sex. PTSD dimensions evidenced differential associations with indicators of threat perception during ACS evaluation and adherence to cardioprotective medication.LimitationsOne limitation of this investigation is the use of self-report measures. In addition, only one-third of the sample was diagnosed with ACS at discharge; the remaining participants received diagnoses such as chest pain without a cardiac diagnosis, another symptom/disease process (e.g., hypertensive chronic kidney disease), or another cardiac disease.ConclusionsFindings suggest that suspected ACS-related PTSD symptoms are best-represented by a 4-factor structure distinguishing between specific (e.g., re-experiencing) and non-specific (dysphoria) symptoms of PTSD that has received support in the broader PTSD literature.