Joint Longitudinal Trajectories of Perceived Stress and Health-Related Quality of Life after First-Time ST-Segment Elevation Myocardial Infarction: A Multicenter Prospective Cohort Study

Background Psychosocial recovery after ST-segment elevation myocardial infarction (STEMI) is not well described, especially regarding how perceived stress and health-related quality of life (HRQoL) change together over time. To jointly characterize the trajectories of stress and HRQoL after first-time STEMI and identify the demographic and behavioral determinants of these trajectories. Methods In a multicenter cohort of 1,730 STEMI survivors, perceived stress and HRQoL were assessed 12, 24, and 36 months after discharge. A bivariate Student-t mixed-effects model estimated joint trajectories and within-person associations, adjusting for age, sex, marital status, education, physical activity, coping, and sleep quality. Results Among 1,730 patients (mean age 56.2 ± 9.9 years; 81.9% men), mean stress increased from 1.28 ± 0.85 at year 1 to 4.72 ± 4.43 at year 2 and then decreased to 3.88 ± 4.13 at year 3, whereas HRQoL changed modestly from 32.67 ± 4.39 to 32.74 ± 4.72 and 33.29 ± 4.82. Stress and HRQoL were moderately negatively correlated (r = − 0.39). Poor sleep quality was associated with higher stress (β = 0.85; 95% CI 0.56–1.14) and lower HRQoL (β = −2.68; 95% CI − 3.33–−2.03), while more adaptive coping was associated with lower stress (β = −0.86; 95% CI − 1.02–−0.70) and higher HRQoL (β = 3.45; 95% CI 3.05–3.84). Conclusions Despite contemporary acute care, psychosocial recovery remains incomplete, with stress and HRQoL tied to sociodemographic and behavioral factors. These joint trajectories identified vulnerable subgroups and highlight the need for psychosocial assessment, coping support, and exercise-based rehabilitation into routine follow-up.