RCT: In acute MI, adding short-term ontopsychological psychotherapy to routine medical therapy reduced new cardiovascular events at 5 years.
Pristipino C, Roncella A, Pasceri V, et al. Short-TErm Psychotherapy IN Acute Myocardial Infarction (STEP-IN-AMI) Trial: Final Results. Am J Med. 2019 May;132(5):639-646.e5. doi: 10.1016/j.amjmed.2018.12.025. Epub 2019 Jan 17.

PURPOSE: The purpose of this research was to assess whether short-term psychotherapy enhances long-term clinical outcomes in patients with a recent 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 only. 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: rates for individual components of the primary composite outcome; the rate of re-hospitalization for cardiovascular problems; and New York Heart Association functional class.

RESULTS: Ninety-four patients were analyzed, translating into 425 patient-years. 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 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: Adding short-term ontopsychological psychotherapy to routine secondary prevention of myocardial infarction improves clinical outcomes overall up to 5 years post AMI. Studying time trends may aid in better targeting of psychological interventions during follow-up. Larger studies remain necessary to confirm these results.

TRIAL REGISTRATION: www.ClinicalTrial.gov NCT00769366.

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Hospital Doctor/Hospitalists

This is an exploratory study looking at the question of short term psychotherapy and outcomes in myocardial infarction. The study was well designed, but small. The final results after five years demonstrated continued advantage to psychotherapy for a composite outcome of 'soft' endpoints. Unfortunately, there was no difference in the groups for major adverse cardiac and cerebrovascular events, but the study was not sufficiently large to detect small improvements. The authors suggest larger similarly designed trials could demonstrate value. Intuitively, psychological care after a major medical event would appear to be beneficial. There are no data yet to suggest specific psychotherapeutic interventions in post MI patients at this time.

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