The Impact of War-Related Stress on Coronary Artery Disease Severity in War Survivors: A SYNTAX Study.
BACKGROUND
Due to the strong relationship between stress and heart disease, particularly acute myocardial infarction (MI), this study investigated the complexity of coronary artery disease (CAD) among Syrian refugee patients referred to Jordan University Hospital and its relation to war-related stressors.


METHODS
This is a retrospective study that utilized the SYNTAX I score in order to evaluate all Syrian refugees that underwent coronary artery catheterization at Jordan University Hospital during the period between May of 2014 and December of 2017.


RESULTS
There was a significant association between war-related stressors and high SYNTAX score (SX score), thus indicating a higher complexity of CAD in Syrian war survivors with higher stress scores. The strongest war-related correlation was observed with crossing green-lines, in which Syrian refugee patients who had crossed such lines had significantly higher SYNTAX scores. Regression analysis demonstrated that war stressors were positive predictors of increased SYNTAX scores even when adjusted for conventional CAD risk factors. Surprisingly, none of the CAD risk factors were significantly associated with SYNTAX score.


CONCLUSION
Our findings suggest that exposure to multiple war-related stressors may increase the complexity and severity of CAD in Syrian war survivors. Thus, special attention, efforts, and resources should be allocated to screen for such vulnerable patients in order to provide them with the appropriate healthcare.
['Al-Makhamreh|Hanna|H|', 'Alkhulaifat|Dana|D|0000-0003-1066-5279', 'Al-Ani|Abdallah|A|0000-0002-3517-3601', 'Mafrachi|Baraa|B|0000-0003-4622-3157', 'Saadeh|Aseel|A|0000-0003-0940-6157', 'Al-Ani|Hashim|H|', 'Bani Hani|Amjad|A|0000-0003-1671-4991', 'AlRyalat|Saif Aldeen|SA|0000-0001-5588-9458']
D017023:Coronary Angiography D003324:Coronary Artery Disease D006801:Humans D007597:Jordan D012189:Retrospective Studies D012720:Severity of Illness Index D017741:Survivors
stress coronary artery disease SYNTAX refugees armed conflicts