A prospective study was conducted to identify predictors of poor psychosocial adjustment 1 year after coronary bypass graft (CABG) surgery. Fifty-two of 61 consecutive patients (mean age = 66 +/- 9, 3 years, 76% men) were studied before and 1 year after surgery. Psychological, social, and surgical data were assessed. The roles of State and Trait anxiety, emotional reactions, and different coping modes were evaluated. At baseline the patients were divided into 3 groups according to their level of anxiety as assessed by Spielberger's State Anxiety Inventory (STAI). The 3 groups did not differ in any of the basic parameters, except for their subjective experience of symptoms of dyspnoea (p < .01), and quality of life (p < .0001) for the whole patient group 1 year after surgery. However, patients belonging to the moderate-anxiety and high-anxiety groups remained more psychologically distressed (p < .0001) and perceived a higher degree of residual angina pectoris (p < .0001) than did patients who did not display anxiety preoperatively. Dividing the patients into groups according to their answers to the other measures of psychological distress or negative coping strategies yielded similar results. The results indicate that the SATI is a valuable instrument for identifying risk patients for poor adjustment after CABG surgery.