Characteristics and Long-Term Prognosis of Holocaust Survivors Presenting with Acute Myocardial Infarction

Background: Catastrophic life events were associated with occurrence of cardiovascular incidents and worsening of clinical course following such events.

Objectives: to evaluate the characteristics and long-term prognosis of Holocaust survivors (HS) presenting with acute myocardial infarction (AMI) compared to non-Holocaust survivors (NHS).

Methods: a retrospective follow-up study was based on computerized medical records of AMI patient hospitalized in Soroka Medical Center in 2002-2012 and included Israeli Jews, who born before 1941. HS were compared with NHS controls using individual age-matching. Personal patients’ characteristics were collected: socio-demographics, cardiovascular risk factors and other comorbidities, type of AMI and hospitalization characteristics. Outcome: all cause long-term (up to 10 years) mortality.

Results: Overall 610 participants (305 HS and 305 age-matched NHS) were included: mean age 83.0±6.7 years, 50.7% males. Higher prevalence of depression (5.9% vs. 3.3% p=0.045) yet similar rate of cardiovascular risk-factors, non-cardiovascular co-morbidity, severity of CAD or in-hospital complications compared with NHS. Throughout the follow-up period, lower cumulative mortality (0.9 vs. 0.96; HR=0.78; 95% CI: 0.64– 0.96; p=0.016), was found among HS compared with NHS (Figure). In a multivariate analysis HS was not found to be an independent predictor of mortality, although some tendency towards reduced mortality was seen (AdjHR=0.84; 95%CI: 0.68-1.03, p=0.094). Depression was associated with a 77.9% increase in the risk for mortality.

Conclusions: HS presenting with AMI are older with increased prevalence of depression, and otherwise similar to NHS. No excessive risk of mortality was observed in HS compared with NHS presenting with AMI. Possibly, specific traits that are associated with surviving catastrophic events counter the excess risk of such events following AMI.