Participants did not differ on any covariate by ED crowding tertile. Their characteristics were as follows: the mean (SD) age, 63.3 (10.7); 72% were men; 23% were African American; and 47% were Hispanic. Thirteen percent had STEMI; 32%, non-STEMI; 55%, UA; 33%, prior myocardial infarction (MI). Their mean (SD) Global Registry of Acute Coronary Events (GRACE) score was 91.2 (29.1); the left ventricular ejection fraction was less than 40 in 16%; the mean (SD) Charlson comorbidity index score was 1.8 (1.7); and the mean BDI score was 8.4 (7.4). Increasing tertiles of ED crowding were associated with higher levels of 1-month ACS-induced PTSD symptoms in univariate analysis (B = 2.0; P < .05). After adjustment for age, sex, education, race/ethnicity, previous MI, GRACE mortality risk score, Charlson comorbidity index, left ventricular ejection fraction of 40% or higher, and in-hospital BDI depression score, increasing tertiles of ED crowding were associated with higher ACS-induced PTSD symptoms at 1 month (B = 2.5; P = .01) (Figure). Further adjustment for ED LOS did not alter the result (B = 3.0; P = .02; N = 99 patients with complete LOS data), and a sensitivity analysis restricted to the 118 patients with non-STEMI and UA yielded nearly identical results.