Mental Stress–Induced Myocardial Ischemia Prognostic

Pooled analysis of 2 US prospective cohort studies of patients with stable coronary heart disease (CHD) suggested that myocardial ischemia with mental stress, compared with no ischemia with mental stress, was significantly associated with an increased risk of cardiovascular (CV) death or nonfatal myocardial infarction (MI). The analysis included 918 patients enrolled between June 2011 and March 2016 (mean age, 60 years; 34% women). During 5-year median follow-up, 16% had mental stress–induced ischemia, 31% had conventional stress ischemia, and 10% had both. The primary end point (a composite of CV death or first or recurrent nonfatal MI) occurred in 156 participants. The pooled event rate was 6.9 and 2.6 per 100 patient-years among patients with and without mental stress–induced ischemia, respectively. The multivariable adjusted hazard ratio (HR) for patients with vs those without mental stress–induced ischemia was 2.5. Compared with patients with no ischemia (event rate, 2.3 per 100 patient-years), patients with mental stress–induced ischemia alone and patients with both mental and conventional stress ischemia had a significantly increased risk (event rate, 4.8, 8.1 per 100 patient-years; HR, 2.0, 3.8, respectively). Patients with conventional stress ischemia alone did not have a significantly increased risk (event rate, 3.1 per 100 patient-years; HR, 1.4). Patients with both mental stress ischemia and conventional stress ischemia had an elevated risk compared with patients with conventional stress ischemia alone (HR, 2.7). The secondary end point (hospitalizations for heart failure) occurred in 319 participants. The event rate was 12.6 and 5.6 per 100 patient-years, respectively for patients with and without mental stress–induced ischemia (adjusted HR, 2.0). The findings suggest that for patients with stable CHD, the presence of mental stress–induced ischemia might indicate an increased CV risk. Source: https://jamanetwork.com/