Meta-Analysis of Mental Stress-Induced Myocardial Ischemia and Subsequent Cardiac Events in Patients With Coronary Artery Disease

• Type of Material: Article
• Authors: Jingkai Wei, Emory University; Cherie Rooks, Emory University; Ronnie Ramadan, Emory University; Amit J. Shah, Emory University; J. Douglas Bremner, Emory University; Arshed Ali Quyyumi, Emory University; Michael Kutner, Emory University; Viola Vaccarino, Emory University
• Language: English
• Date: 2014-07-15
• Publisher: EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2014 Elsevier Inc. All rights reserved. CC BY NC ND 4.0
• Final Published Version (URL): http://dx.doi.org/10.1016/j.amjcard.2014.04.022
• Title of Journal or Parent Work: American Journal of Cardiology
• Volume: 114
• Issue: 2
• Start Page: 187
• End Page: 192
• Grant/Funding Information: This work was supported by grants R01 HL109413; 2R01 HL068630; 2K24HL077506; K24 MH076955; R01 HL088726; P01 HL101398 KL2TR000455; and UL1TR000454 from the National Institutes of Health.
• Keywords: Cardiac & Cardiovascular Systems; RESPONSES; VENTRICULAR-ARRHYTHMIAS; Cardiovascular System & Cardiology; Life Sciences & Biomedicine; IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS; Science & Technology; T-WAVE ALTERNANS
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Medicine and Surgery; Biology, Biostatistics

Abstract

Mental stress-induced myocardial ischemia (MSIMI) has been associated with adverse prognosis in patients with coronary artery disease (CAD), but whether this is a uniform finding across different studies has not been described. We conducted a systematic review and meta-analysis of prospective studies examining the association between MSIMI and adverse outcome events in patients with stable CAD. We searched PubMed, EMBASE, Web of Science, and PsycINFO databases for English language prospective studies of patients with CAD who underwent standardized mental stress testing to determine presence of MSIMI and were followed up for subsequent cardiac events or total mortality. Our outcomes of interest were CAD recurrence, CAD mortality, or total mortality. A summary effect estimate was derived using a fixed-effects meta-analysis model. Only 5 studies, each with a sample size of <200 patients and fewer than 50 outcome events, met the inclusion criteria. The pooled samples comprised 555 patients with CAD (85% male) and 117 events with a range of follow-up from 35 days to 8.8 years. Pooled analysis showed that MSIMI was associated with a twofold increased risk of a combined end point of cardiac events or total mortality (relative risk 2.24, 95% confidence interval 1.59 to 3.15). No heterogeneity was detected among the studies (Q = 0.39, I2 = 0.0%, p = 0.98). In conclusion, although few selected studies have examined the association between MSIMI and adverse events in patients with CAD, all existing investigations point to approximately a doubling of risk. Whether this increased risk is generalizable to the CAD population at large and varies in patient subgroups warrant further investigation.