The following is a summary of “Association Between Symptoms of Chronic Psychological Distress and Myocardial Ischemia Induced by Mental Stress in Patients With Coronary Artery Disease,” published in the November 2023 issue of Cardiology by Moazzami et al.

In patients diagnosed with coronary artery disease, mental stress-induced myocardial ischemia significantly impacts future cardiovascular events. Yet, the connection between persistent psychological distress symptoms and this type of ischemia remains unclear. Utilizing a composite score derived from symptoms of depression, posttraumatic stress disorder, anxiety, anger, and perceived general stress, researchers investigated this association. Participants underwent myocardial perfusion imaging with both mental and conventional stress tests. Approximately 15.9% experienced mental stress-induced myocardial ischemia. After adjusting for various factors, patients with the highest psychological distress scores had a 35% greater likelihood of experiencing mental stress-induced ischemia compared to those with the lowest scores (odds ratio [OR], 1.35 [95% CI, 1.06–2.22]). 

However, this association was notably significant only in patients with a history of prior myocardial infarction, where those in the highest distress tertile had a 93% higher chance of developing mental stress-induced ischemia (95% CI, 1.07–3.60). No substantial association was observed between psychological distress and conventional stress-induced ischemia (OR, 1.19 [95% CI, 0.87–1.63]). These findings underscore the specific link between psychosocial distress and mental stress-induced myocardial ischemia, particularly in patients with a history of myocardial infarction, while conventional stress tests do not exhibit such associations.

Source: ahajournals.org/doi/10.1161/JAHA.123.030305