Association of Mental Stress–Induced Myocardial Ischemia With Cardiovascular Events in Patients With Coronary Heart Disease
Pooled resultResult — go to the resultHazard ratio 2.5 95% CI 1.8–3.5Authors' conclusion
Among patients with stable coronary heart disease, the presence of mental stress-induced ischemia, compared with no mental stress-induced ischemia, was significantly associated with an increased risk of cardiovascular death or nonfatal myocardial infarction.
Study context
- Population
- Patients with stable coronary heart disease (CHD) (MIPS and MIMS2 cohorts), enrolled June 2011–March 2016618 MIPS, 300 MIMS2
- Participants
- 918 patients
- Comparison
- Mental stress-induced ischemia vs no mental stress-induced ischemia
- Mental stress-induced ischemian = 147
- Outcome
- CV death or first or recurrent nonfatal MI
- Follow-up
- 5-year median
Methodological detailsuniversity-based hospital network, Atlanta, Georgia
- University-based hospital network, Atlanta, Georgia
Pooled result
As reported in the abstract
Hazard ratio
2.5
95% CI 1.8–3.5
By group
MSI
6.9 per 100 patient-years
No MSI
2.6 per 100 patient-years
MSIvs No MSI
HR 2.5 (95% CI 1.8–3.5)
Further pooled results
| Outcome | No mental stress-induced ischemia | HR (95% CI) | |
|---|---|---|---|
| Primary end point by ischemia category (vs no ischemia, 2.3 per 100 patient-years)MSI alonevs No ischemia | 2.3 per 100 patient-years | 2.0 (1.1–3.7) | |
| Primary end point by ischemia category (vs no ischemia, 2.3 per 100 patient-years)Both MSI and conventional stress ischemiavs No ischemia | 3.8 (2.6–5.6) | ||
| Primary end point by ischemia category (vs no ischemia, 2.3 per 100 patient-years)Conventional stress ischemia alonevs No ischemia | 1.4 (0.9–2.1) | ||
| Primary end point by ischemia category (vs no ischemia, 2.3 per 100 patient-years)Both MSI and conventional stress ischemiavs Conventional stress ischemia alone | 2.7 (1.7–4.3) | ||
| Secondary end point (CV death, nonfatal MI or HF hospitalization)MSIvs No MSIAdjusted | 2.0 (1.5–2.5) | ||
| 0.20.5125Hazard ratio (log scale) |
- Primary end point by ischemia category (vs no ischemia, 2.3 per 100 patient-years): MSI alone 4.8 per 100 patient-years
- Primary end point by ischemia category (vs no ischemia, 2.3 per 100 patient-years): Both MSI and conventional stress ischemia 8.1 per 100 patient-years
- Primary end point by ischemia category (vs no ischemia, 2.3 per 100 patient-years): Conventional stress ischemia alone 3.1 per 100 patient-years
- Secondary end point (CV death, nonfatal MI or HF hospitalization): MSI 12.6 per 100 patient-years
- Secondary end point (CV death, nonfatal MI or HF hospitalization): No MSI 5.6 per 100 patient-years
- Secondary end point (CV death, nonfatal MI or HF hospitalization): occurred in 319 participants
Original publication
Association of Mental Stress–Induced Myocardial Ischemia With Cardiovascular Events in Patients With Coronary Heart Disease. JAMA. Published 9 November 2021. doi:10.
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